局限性肾癌微血管侵犯的临床意义

目的　探讨微血管侵犯在肾癌根治术后患者预后判断中的作用。　方法　选取局限性肾癌患者肾癌根治术后标本 70例。临床分期 :PT15例 ,PT2 5 0例 ,PT3 14例 ,PT41例 ;组织学分级 :G17例 ,G2 38例 ,G3 19例 ,G46例。 70例肿瘤平均直径 7.2cm。采用HE染色、弹力纤维染色、Schiff染色制片 ,观察肾癌微血管侵犯情况 ,并与分期、分级等病理因素进行比较研究。　结果　微血管侵犯者 2 4例 (34.3% ) ,其中出现转移 11例 (4 5 .8% ) ,死于肿瘤复发 7例 ,4例仍带瘤存活 ,死于其他疾病者 2例 ;4 6例无微血管侵犯者中出现转移 4例 (8.7% ) ,两组生存时间比较 ,差异有显著性意义 (P <0 .0 1)。微血管侵犯和肿瘤分期、分级、体积均相关 ,多因素分析表明 :微血管侵犯、肿瘤体积均是预测生存率的重要因素 ,微血管侵犯为影响患者预后的最重要的相关因素。　结论　微血管侵犯可作为局限性肾癌根治性肾切除术后重要的预后因素之一 ,并可作为肾癌常规临床病理检查的一种补充形式 ,按照有、无微血管侵犯作进一步分型 ,可为肾癌患者的预后提供更全面的预测。

The clinical significance of microvascular invasion to the neogrowth in clinically nonmetastatic renal cell carcinoma

Objective To study the significance of microvascular invasion to the neogrow in clinically nonmetastatic renal cell carcinoma (RCC). Methods Between 1989 and 1996,70 patients (mean age 54) were followed up for 1 to 7 years after radical nephrectomy for clinically localized RCC. Among them,there were 5 PT 1,50 PT 2,14 PT 3 and 1 PT 4 and histologically 7 G 1,38 G 2,19 G 3 and 6 G 4.The mean tumor diameter was 7.2 cm.The slides were stained with hematoxylin and eosin,elastin stains and periodic acid Schiff. then,the presence or absence of clinically inapparent vascular invasion,the relevance of microscopic vascular invasion to conventional tumor stage,grade and tumor diameter,et al were studied. Results Of the 70 patients analyzed,24(34.3%) had microvascular invasion,while 46 had none on microscopic examination.Of the microscopic vascular invasion group (11/24,45.8%),7 subsequently died of cancer recurrence,2 noncancer related death,4 alive with metastatic disease while only 4/46(8.7%) without microscopic vascular invasion presented with disease progression.Chi-square test showed statisticaly significant difference between stage,grade,tumor diameter and presence or absence of microscopic vascular invasion. A multivarite analysis was performed considering the impacts of age,PT stage,tumor grade,tumor diameter and microscopic vascular invasion on disease progression,an increase in statistical significance was confirmed with Coxs proportional hazards model(P=0.0062,RR=0.378). So, microscopic vascular invasion seems to be the most important predictor of progression in RCC. Conclusions In patients underwent radical nephrectomy for clinically nonmetastatic RCC,microvascular invasion may be another important prognostic marker and this makes us considering the presence of microscopic vascular invasion in RCC might be another pathological subcategory to predict the prognosis of RCC and can be used to choose whether early adjuvant therapy is necessary.