肾透明细胞癌孤立转移瘤的手术治疗

目的探讨肾透明细胞癌转移瘤的手术治疗及预后。方法回顾性分析5例肾透明细胞癌转移瘤行手术治疗患者的临床资料。本组5例,男3例,女2例,发病年龄42～73岁。转移部位:肺转移3例(其中1例肺转移2次),骨转移1例,脑转移1例(该患者发生2次脑转移),局部复发1例,鼻腔转移1例(该患者发生4次鼻腔转移)。均手术切除患肾及转移瘤。结果随访7月～16年,3例存活大于15年,1例已存活超过1年,1例肾切除术后7月死亡。结论对肾透明细胞癌孤立的转移瘤和局部复发灶应积极手术切除,可以延长患者生存期和提高生活质量。     

Patient survival after surgery for osseous metastases from renal cell carcinoma

BACKGROUND: Skeletal metastases from renal cell carcinoma are highly destructive vascular lesions. They pose unique surgical challenges due to the risk of life-threatening hemorrhage and resistance to other treatments. The goal of this retrospective study was to evaluate factors that may affect survival after surgical treatment of metastases of renal cell carcinoma. METHODS: We performed a retrospective review of a series of 295 consecutive patients who had been treated for metastatic renal cell carcinoma at one institution between 1974 and 2004. There were 226 men and sixty-nine women. A total of 368 metastases of renal cell tumors to the extremities and pelvis were treated. The surgical procedures included curettage with cementing and/or internal fixation (214 tumors), en bloc resection (117), closed nailing (twenty-seven), amputation (four), and other measures (six). Overall survival was calculated with Kaplan-Meier analysis. The log-rank test was used to evaluate the effect of different variables on overall survival. RESULTS: The overall patient survival rates at one and five years were 47% and 11%, respectively. The metastatic pattern had a significant effect on the survival rate (p < 0.0001): patients with a solitary bone metastasis had the most favorable overall survival rate. Patients with multiple bone-only metastases had a better survival rate than patients with pulmonary metastases (p = 0.009). A clear-cell histological subtype was also associated with better survival (p < 0.0001). The tumor grade did not predict survival (p = 0.17). Fifteen patients (5%) died within four weeks after surgery. The causes included acute pulmonary failure (seven patients), multiorgan failure (six), cerebrovascular accident (one), and hypercalcemia (one). There were no deaths attributable to intraoperative hemorrhage. Discussion: Survival beyond twelve months is possible for a substantial proportion of patients with metastatic renal cell carcinoma. Patients with a clear-cell histological subtype, bone-only metastases, and a solitary metastasis have superior survival rates. The presence of pulmonary metastases does not predict early death in a reliable manner, and some patients may survive for years with pulmonary and systemic disease. The data are important for surgeons to consider when choosing treatment for these patients. For example, local control of disease and implant stability are important issues for patients with a potential for a long duration of survival.     

Intradural spinal metastasis of renal cell cancer. Report of a case and review of 26 published cases

Metastatic disease in the intradural compartment of the spine is a rare manifestation of cancer. We report the case of an 82-year-old patient with an intradural, extramedullary metastasis of renal cell carcinoma in the cervical spine. A literature search for intradural spinal metastases of renal cell carcinoma yielded a total of 26 further cases. 18 patients had sporadic renal cell carcinoma, and 9 patients had von Hippel-Lindau disease (VHL) in which the metastases of the renal cell carcinoma were embedded within spinal haemangioblastomas. Patients presented with paresis, back pain, altered sensation or, less frequently, bladder dysfunction. Intradural spinal metastases were diagnosed at an earlier age in VHL patients than in sporadic cases (mean 43 ± 5 years vs. 60 ± 14.5 years). The metastasis was surgically removed in 81% of patients. Pain improved in all patients, paresis in 90%, hypaesthesia in 38% and bladder dysfunction in 50%. Death occured as a result of systemic cancer progression. 93% of patients in the sporadic renal cell cancer group died within 1.5 years, whereas two thirds of the VHL patients were alive after 2 years.     

肾细胞癌保留肾单位手术的长期随访

目的 探讨保留肾单位手术治疗肾细胞癌的长期疗效及安全性. 方法 回顾性分析243例保留肾单位手术的肾癌患者临床资料.男159例,女84例,平均年龄58(24～77)岁.肿瘤直径平均3.4(1.1～6.7)cm.孤立肾肾癌3例,双侧肾癌11例.TNM分期T_(1a) 237例,T_(1b) 6例;无区域淋巴结及远处转移,无肾静脉、腔静脉癌栓.术后随访行超声、CT、肾功能等检查.应用KaplanMeier方法行肿瘤特异性生存率估计并进行对数秩检验. 结果 243例中232例获随访,平均随访31(1～147)个月.术后应用干扰素继续治疗52例.死亡4例(因癌死亡1例,非癌死亡3例),总体生存率和肿瘤特异性生存率分别为98.3%和100.0%;肿瘤复发5例,远处转移1例.总并发症发生率为5.6%(13/232). 结论 保留肾单位手术治疗肾细胞癌局部复发率低,远期生存率高,并发症发生率低;可以最大限度地保留功能性肾单位,降低并发慢性肾衰竭的危险性,提高患者生活质量,增加患者满意度.     

Survival and prognostic classification of patients with metastatic renal cell carcinoma of bone

OBJECTIVES: We retrospectively analyzed the survival of renal cell carcinoma patients with bone metastases, and identified prognostic factors and a model predictive for survival in these patients. METHODS: Fifty patients with renal cell carcinoma with osseous metastases were treated at Hokkaido University Hospital between 1980 and 2004. The relationship between several clinical features and survival was examined univariately. The Cox proportional hazards model was then used to form a multivariate model. RESULTS: The median survival time from the diagnosis of bone metastasis was 12 mo, and overall survival at 2 yr was 37%. Clinical features correlated with longer survival in the multivariate analysis were a long interval (24 mo or more) between the diagnosis of kidney cancer and that of osseous metastasis (hazard ratio [HR]: 2.608; 95% confidence interval [CI], 1.031-6.599) and the absence of extraosseous metastases (HR: 2.523; 95%CI, 1.023-6.220). By combining these two favorable factors, renal cell carcinoma patients with osseous metastases could be categorized into two different groups. The median time to death in 20 patients with zero favorable factors (poor prognosis) was 5 mo. On the other hand, 30 patients had one or two favorable factors (good prognosis); the median survival time in this group was 30 mo. There was a significant difference in survival duration between the two groups (p<0.001). CONCLUSIONS: Two prognostic factors predicting survival were identified and used to categorize renal cell carcinoma patients with bone metastasis into two prognostic groups.     

Results of surgical treatment of renal cell carcinoma with solitary metastasis

To determine the effect on survival of excision of a solitary metastasis from renal cell carcinoma, the records of 29 patients seen at our institute within the last 15 years (1972 to 1986) who underwent such an operation were reviewed. Metastasis was present at diagnosis in 11 of the 29 patients, while 18 had metastasis 2 months to 11 years after nephrectomy, with an average interval free of disease of 38 months. There were 13 pulmonary metastases, 6 bone lesions and 10 other lesions. The estimated over-all survival rate for this group was 41 per cent at 2 years and 13 per cent at 5 years after excision of the metastasis. Only 2 of the 29 patients currently are alive with no evidence of disease 42 and 53 months since excision of the metastasis. Neither the presence nor absence of a metastasis at diagnosis nor the interval between nephrectomy and the development of a metastasis in patients without metastatic disease at diagnosis appeared to influence survival after excision of the metastasis. Unlike previous reports, these results suggest that the beneficial effects of excision of metastatic renal cell carcinoma are limited to improved short-term survival postoperatively and that surgical cure of patients with metastatic renal cell carcinoma is a relatively uncommon event.     

Surgical treatment of osseous metastases in patients with renal cell carcinoma.

Forty-five patients who underwent surgical treatment for osseous metastases secondary to renal cell carcinoma between 1980 and 1998 were reviewed. The diagnosis was confirmed histologically in all patients. The mean age of the 34 men was 61.5 +/- 9 years and of the 11 women 55.2 +/- 17.6 years. The most common locations of the metastases were the spine (15 patients), the pelvis (eight patients), and the femur (11 patients). In 21 patients, the renal cell carcinoma was diagnosed when the osseous metastasis was detected. The time from diagnosis of the primary tumor to metastasis in the remaining patients ranged from 0 to 23 years (mean, 3 +/- 5 years). At presentation, 19 patients had a singular lesion. Nine patients had multiple osseous metastases and 17 patients had additional visceral involvement. In seven patients, a wide or radical resection was done; in 35 patients, a palliative procedure was done; and in three patients, only a diagnostic procedure was done. For the whole group, the survival was 49% after 1 year, 39% after 2 years, and 15% after 5 years. Only the extent of the disease and the latency period between primary tumor diagnosis and first detection of osseous metastasis could be identified as independent factors of survival. Nine patients with solitary metastasis to the bone more than 12 months after resection of the primary tumor showed a 5-year survival of 54%.     

Evaluation of bone metastases from renal cell carcinoma

Twenty-nine cases of bone metastases from renal cell carcinoma were examined. Eight had metastatic bone pain as the initial symptom and were diagnosed that the primary lesion was in a kidney. In eight cases bone metastases appeared after treatment of the primary site. Seven had only bone metastases and another 22 cases had multiple metastases in organs such as the lung and lymph node when the bone metastasis was found. Curable surgical treatment was performed in only 2 cases. The survival curve of these patients were: 1 year; 41 per cent, 2 year; 30 per cent and 3 year; 15 per cent. Bone scan used for detection of bone metastases of carcinoma frequently ends with false positive results. CT scan and angiography are available for differential diagnosis of bone metastasis. We examined 6 cases (9 lesions) of bone metastases from renal cell carcinoma (3 pelvic bones, 2 lumbar bones, 2 femurs and 2 humerus). All lesions were hypervascular by angiography and were easily diagnosed as bone metastases. For early detection of bone metastases from renal cell carcinoma, angiography is useful because hypervascularity and tumor stain are easily detected even in such small lesions as 2 cm. Angiography was also useful for chemoembolization.     

Radiosurgery in patients with renal cell carcinoma metastasis to the brain: long-term outcomes and prognostic factors influencing survival and local tumor control

OBJECT: Renal cell carcinoma is a leading cause of death from cancer and its incidence is increasing. In many patients with renal cell cancer, metastasis to the brain develops at some time during the course of the disease. Corticosteroid therapy, radiotherapy, and resection have been the mainstays of treatment. Nonetheless, the median survival in patients with renal cell carcinoma metastasis is approximately 3 to 6 months. In this study the authors examined the efficacy of gamma knife surgery in treating renal cell carcinoma metastases to the brain and evaluated factors affecting long-term survival. METHODS: The authors conducted a retrospective review of 69 patients undergoing stereotactic radiosurgery for a total of 146 renal cell cancer metastases. Clinical and radiographic data encompassing a 14-year treatment interval were collected. Multivariate analyses were used to determine significant prognostic factors influencing survival. The overall median length of survival was 15 months (range 1-65 months) from the diagnosis of brain metastasis. After radiosurgery, the median survival was 13 months in patients without and 5 months in those with active extracranial disease. In a multivariate analysis, factors significantly affecting the rate of survival included the following: 1) younger patient age (p = 0.0076); 2) preoperative Karnofsky Performance Scale score (p = 0.0012); 3) time from initial cancer diagnosis to brain metastasis diagnosis (p = 0.0017); 4) treatment dose to the tumor margin (p = 0.0252); 5) maximal treatment dose (p = 0.0127); and 6) treatment isodose (p = 0.0354). Prior tumor resection, chemotherapy, immunotherapy, or whole-brain radiation therapy did not correlate with extended survival. Postradiosurgical imaging of the brain demonstrated that 63% of the metastases had decreased, 33% remained stable, and 4% eventually increased in size. Two patients (2.9%) later underwent a craniotomy and resection for a tumor refractory to radiosurgery or a new symptomatic metastasis. Eighty-three percent of patients died of progression of extracranial disease. CONCLUSIONS: Stereotactic radiosurgery for treatment of renal cell carcinoma metastases to the brain provides effective local tumor control in approximately 96% of patients and a median length of survival of 15 months. Early detection of brain metastases, aggressive treatment of systemic disease, and a therapeutic strategy including radiosurgery can offer patients an extended survival.     

Metastatic renal cell carcinoma to the thyroid gland: report of seven cases and review of the literature

PURPOSE: The aim of this study was to retrospectively report clinical manifestations, type of treatment, survival rate of thyroid metastases from renal carcinoma. PATIENTS AND METHODS: Seven patients were retrospectively collected from files of different Burgundy's hospitals. All renal and thyroid gland specimens were controlled by the anatomopathologist. RESULTS: Tumors occurred in four women and three men (mean age: 66 years). Symptoms were generally a solitary mass. The metastatic tumor to the thyroid gland was the initial presentation of renal carcinoma in one case. In the other cases, patients had documented previous evidence of renal carcinoma as remotely 8.1 years before the thyroid metastases. Thyroglobulin immunohistochemistry was always negative in the foci of metastatic renal carcinoma. All patients had surgical resection of there metastasis. The majority of patients died with disseminated malignancies (mean: 38.1 months after there thyroid resection). Three patients are still alive, one after a complementary pancreatic resection for a secondary pancreatic metastasis and one other with cervical and mediastinal lymph node recurrence. CONCLUSIONS: Surgical treatment of the metastatic disease is suggested, as this may prolonged patient survival.     

Renal cell carcinoma in the solitary kidney: an analysis of complications and outcome after nephron sparing surgery

PURPOSE: We evaluated surgical techniques, pathological features and extended outcomes in patients with renal cell carcinoma in a solitary kidney treated with surgical excision. MATERIALS AND METHODS: Between 1970 and 1998, 76 patients underwent nephron sparing surgery for sporadic renal cell carcinoma in a solitary kidney, including 63 with tissue specimens available for pathological review who comprised the cohort. Six (9.5%) patients had a congenitally absent kidney and 57 (90.5%) had previously undergone contralateral nephrectomy for renal cell carcinoma. The clinical and pathological features examined were patient age at nephron sparing surgery, sex, type of nephron sparing surgery (enucleation, partial nephrectomy or ex vivo resection), tumor size, nuclear grade, histological subtype and 1997 tumor stage. Overall cancer specific, local recurrence-free and metastasis-free survival as well as early (within 30 days of nephron sparing surgery) and late (30 days to 1 year after nephron sparing surgery) complications were assessed. Univariate and multivariate analyses were done to test for the associations of clinical and pathological features with outcome. RESULTS: Most patients were treated with enucleation (36.5%), standard partial nephrectomy (38.1%) or the 2 procedures (11.1%) and in 8 (12.7%) ex vivo tumor resection was done. The renal cell carcinoma histological subtypes were clear cell in 82.5% of cases, papillary in 15.9% and chromophobe in 1.6%. Grade was 1 to 3 in 10 (15.9%), 42 (66.7%) and 10 (15.9%) tumors, respectively. At 5 and 10 years the overall survival rate was 74.7% and 45.8%, the cancer specific survival rate was 80.7% and 63.7%, the local recurrence-free survival rate was 89.2% and 80.3%, and the metastasis-free survival rate was 69% and 50.4%, respectively. Tumor stage and nuclear grade were significantly associated with death from any cause, death from renal cell carcinoma and distant metastases on multivariate analysis. Notably no patient with papillary or chromophobe renal cell carcinoma died of renal cell carcinoma, or had recurrence or metastasis. The type of nephron sparing surgery was not significantly associated with outcome, although there were too few patients with recurrence to assess the association of the type of nephron sparing surgery with local recurrence. The most common early complication was acute renal failure in 12.7% of cases, while the most common late complications were proteinuria in 15.9% and renal insufficiency in 12.7%. CONCLUSIONS: The 1997 tumor stage and nuclear grade were significant predictors of death from any cause, death from renal cell carcinoma and distant metastases in patients treated with nephron sparing surgery for renal cell carcinoma involving a solitary kidney. Nephron sparing surgery in a solitary kidney can be performed safely and with minimal morbidity.     

Sarcomatoid carcinoma of the kidney

Among 315 cases of parenchymal renal carcinoma resected between 1975 and 1985, 19 cases (6 per cent) of sarcomatoid carcinoma were identified. All patients were symptomatic or had a palpable mass in the flank at hospitalization. Tumor stage generally was advanced at operation and metastases were detected in 8 patients (Robson stage IV), all of whom died after an average postoperative survival of 8 months. In 3 patients there was tumor invasion of the renal vein (Robson stage IIIA), and they died after an average postoperative period of 11 months. Of 4 patients with perinephric fat invasion (Robson stage II) 2 died of cancer after an average survival of 15 months and 2 are alive with no evidence of disease for an average of 73 months postoperatively. In these later 2 cases the sarcomatoid areas constituted less than 5 per cent of the entire tumor and the remaining tumor was low grade carcinoma. In 3 patients adequate followup is not available and 1 was lost to followup. This histological variant of parenchymal cell carcinoma is a high grade malignancy with a poor prognosis. Operative treatment appears to be ineffective in modifying the behavior of the tumor.     

Analysis of renal cell carcinoma with tumorous legion in the liver

We presented 3 cases of renal cell carcinoma with hepatic lesion, for which it was difficult to make a diagnosis preoperatively. The hepatic lesion was cavernous hemangioma of the liver, liver metastasis of renal cell carcinoma or hepatocellular carcinoma. To discuss the strategy of treatment for liver metastasis of renal cell carcinoma at the time of nephrectomy, or in the follow-up period after nephrectomy, we reviewed the 188 cases of renal cell carcinoma which were nephrectomized from December, 1962 to June, 1988. At the time of nephrectomy, there was only 1 case that had concurrent liver metastasis. In 4 cases, liver metastasis was found at autopsy, and in 15 cases, in the follow-up period after nephrectomy. We analysed these 15 cases and classified them into 2 groups. One was "early metastasis group", i.e., liver metastasis was found within 18 months after nephrectomy, and the other was "late metastasis group", i.e., liver metastasis detected more than 6 years after nephrectomy. In the "early metastasis group", 2 lived 10 months or 57 months, but 5 died within 1 month after the appearance of liver metastasis. In the "late metastasis group", 4 of 7 lived more than 2 years after the appearance of liver metastasis and the median survival was 21 months. In both groups, when liver metastasis was found, there were metastases in multiple organs and the hepatic lesions were multiple.(ABSTRACT TRUNCATED AT 250 WORDS)     

Surgical treatment of renal cell carcinoma with bone metastasis

Eighty-six patients with renal cell carcinoma underwent radical nephrectomy in Chiba Cancer Center Hospital. Fifteen of the 86 patients developed bone metastases. Seven of the 15 patients with bone metastases had received chemotherapy and radiotherapy. Six of the 15 patients underwent surgical treatment and two received radiotherapy alone. Of the six patients treated surgically for bone metastases, two patients were treated with wide resection and the remaining four patients underwent excision of the metastatic lesions in combination with radiotherapy, chemotherapy or immunotherapy. One of the two patients who underwent wide resection of a pelvic bone lesion is alive without evidence of disease for 6 years and 4 months. Another patient who underwent wide resection of femoral bone lesion survived for 14 years and 2 months but died of recurrent cancer. Pathologic findings of renal cell carcinoma in the long-time survivors showed adenocarcinoma of alveolar type of clear cell subtype and in grade 1. Wide resection of bone metastases of renal cell carcinoma can significantly prolong the survival time and improve the quality of life of the patients.     

Surgical therapy in lung cancer with single brain metastasis

From January 1975 to April 1987, 27 patients underwent surgical resection of non oat cell lung cancer and a single brain metastasis. There were 25 men and 2 women ranging in age from 37 to 70 years. In 21 cases the brain metastasis was synchronous while in 6 cases the onset was metachronous. In 17 cases, the site of the brain metastasis was supratentorial and in 10 cases it was located in the posterior fossa. The chest X-ray confirmed the primary lung tumour in 24 cases. In 3 cases, only bronchoscopy and cytology revealed the primary focus of the tumour. The lung cancer was located in the upper lobe in 25 patients. Upper lobectomy was performed in 23 patients, pneumonectomy in 3, and lower lobectomy in 1. There were no operative deaths. The cell type was adenocarcinoma in 19 cases, squamous cell carcinoma in 4 patients and large cell carcinoma in 4. Only the tumour and nodes were used for staging at thoracotomy. The classification was: 12 patients in stage I, 2 in stage II, and 13 in stage III. At conclusion of the study the longest survival was 68 months after thoracotomy. There was no significant difference in the duration of survival in patients over or under 50 years old. Better results were obtained in patients without node metastases at thoracotomy (median survival of 30 months and an overall 5-year survival of 35%), and in patients with supratentorial metastases (median survival of 22 months and an overall 5-year survival of 23.4%). Our experience confirms that combined surgery prolongs survival and improves the quality of life.     

Intrathyroidal metastases of a nephroepithelioma. Reflections on 5 operated cases

Out of 3,340 thyroidectomies (237 for cancer), the authors report 5 cases of thyroid metastases due to clear cell renal cancer. They emphasize the slow development of these metastases. Two cases were operated on 11 years after nephrectomy and one after 27 years. In one case, an intrathyroid metastasis led to the discovery of renal carcinoma. In 3 cases, evolution was rapidly fatal (within the first year). One patient is still alive 6 years after thyroidectomy. The authors emphasize clinical grounds for diagnosis and expose pathology findings that favor longer survival when there is early removal of intrathyroid metastases.     

��ϸ�����̷�����ת�Ƶ���ϼ����ƣ���5�����棩

??Diagnosis and treatment of secondary pancreatic metastasis of renal cell carcinoma: A report of 5 patients and review of the literature CHEN Yi-ran, XIE Xue-hai, CHEN Guo-wei, et al. Department of General Surgery, Peking University First Hospital, Beijing 100034, China
Corresponding author: YANG Yin-mo, E-mail: yangyinmo@263.net
Abstract Objective To study the diagnosis and management of secondary pancreatic metastasis of renal cell carcinoma. Methods The clinical data of 5 patients with secondary pancreatic metastasis of renal cell carcinoma identified pathologically and followed up completely between 2000 and 2013 in Department of General Surgery, Peking University First Hospital were analyzed retrospectively. Results Among 5 patients, pancreatic metastases were found in 20 months, 7, 11, 12 and 15 years respectively after nephrectomy. Computed tomography (CT) and endoscopic ultrasonography (EUS) with history could establish a definite diagnosis preoperatively. Two patients were performed total pancreatectomy due to multi-focal lesions. Two patients were performed pancreaticoduodenectomy due to the location of solitary metastasis. The other one patient was not treated surgically for individual reason. Of the 4 patients underwent surgery, 3 patients were alive without recurrence and metastasis throughout the follow-up. The other 1 patient died of cardiac-cerebral vascular disease 1 year after surgery. The patient without surgery died of upper gastrointestinal bleeding 6 years after pancreatic metastases. Conclusion Metastatic pancreatic cancer is rare. For resectable pancreatic metastasis from renal cell carcinoma, different kinds of pancreatic resection are curative and can increase life expectancy of patients.     

肾癌区域淋巴结转移的临床分析

目的 了解肾癌区域淋巴结转移的临床特点及发生发展规律,提高对本病的诊治效果.方法 回顾性分析2004年1月至2008年12月19例肾癌伴有区域淋巴结转移患者的资料.男15例,女4例.年龄29～77岁,中位年龄57岁.肿瘤位于左肾12例,右肾7例.腹膜后肿大淋巴结最大径1.5～5.0 cm,中位数2.8 cm,其中4例影像学检查未发现肿大淋巴结,术中探查证实.行腹膜后肿大淋巴结切除11例,区域淋巴结清扫8例.结果 肾癌发生区域淋巴结转移占同期收治肾癌的1.6%(19/1213).术后19例均获随访,随访时间8～78个月,中位数34个月.无瘤生存6例,带瘤生存7例,死亡6例,5年生存率68.4%.腹膜后区域淋巴结清扫组与肿大淋巴结切除组生存期及术后复发转移率比较差异均无统计学意义(P=0.644;P=0.319).结论 肾癌发生单纯区域淋巴结转移少见,术前影像学可能漏诊,部分患者通过区域淋巴结清扫或肿大淋巴结切除可获得无瘤生存.

Abstract：

Objective To discuss the characteristics of renal cell carcinoma with regional lymph node metastasis at diagnosis. Methods The data of 19 patients diagnosed with renal cell carcinoma with regional lymph node metastases at diagnosis from January 2004 to December 2008 were reviewed.The median age was 57 years (29-77).The study group included 15 males and four females.The primary tumor was located in the left kidney in 12 patients and fight in seven patients.The median maximam diameter of retroperitoneal lymph nodes was 2.8 cm(1.5-5.0).The lymph nodes in four patients were not detected by the preoperative image examination,but were confirmed by intraoperative exploration.Eleven cases had enlarged retroperitoneal lymph nodes resected and eight had regional lymph nodes dissected. Results The patients with regional lymph node metastases at diagnosis of renal celI carcinoma accounted for 1.6% (19/1213) of the total renal cell carcinoma cases.With a median follow-up of 34 months,six patients were survival without progression,and seven were survival with progression.giving a 5-year survival rate of 68.4%.The survival and recurrence rates after surgery were not significantly different by Fisher test(P=0.644 and 0.319 respectively) between the patients who underwent retroperitoneal regional lymph node dissection and those who underwent enlarged lymph node resection. Condmiom Renal cell carcinoma with regional lymph node metastasis at diagnosis is uncommon.Some patients may achieve long-term tumor-free survival through regional lymph node dissection or enlarged Iymph nodes resection.     

Clinical study on incidental renal cell carcinoma]

Of 93 patients with renal cell carcinoma treated at our hospital between January 1974 and December 1990, thirty-two cases with incidentally detected cancer were evaluated clinically and pathologically. The average age of the patients was 61 years old ranging from 39 to 84 years. There were 25 men and 7 women with a sex ratio of 3.6:1. Fourteen tumors had developed in the right kidney and 17 in the left kidney. One patient had bilateral tumors synchronously and was treated by radical nephrectomy with contralateral enucleation of the tumor. The proportion of incidental renal carcinoma has been increasing steadily; 87.5% of the cases was found by either abdominal ultrasonography or CT scan. Nineteen patients (59.4%) had a tumor smaller than 5 cm in diameter. There were 29 cases with G1 or G2 renal cancer and twenty with pT2. The five-year survival rate in the incidental cases was 52.2% with significantly better survival than in cases when metastasis was initially suspected, but there was no significant difference in survival between the incidentally found cases and the cases of symptomatic renal cancer.     

Clinical study of sarcomatoid renal cell carcinoma

Patients with sarcomatoid renal cell carcinoma are rare and have poor survival. We evaluated 14 patients who had renal cell carcinoma with a sarcomatoid component between 1982 and 2000. There were 9 men and 5 women with a median age of 59.5 years (range 32 to 77). Seven patients had a tumor on the right side and 7 on the left side. Thirteen patients had some symptoms and 11 had metastases at the initial visit. Most of them were stage T4 and high nuclear grade cancer and showed elevated acute phase reactants. There were 7 patients followed by interferon therapy, and the cause-specific 5-year survival rate was less than 10%. We confirmed that renal cell carcinoma with a sarcomatoid component often showed local invasion, distant metastasis and poor prognosis.