多房囊性肾细胞癌与透明细胞性肾细胞癌的免疫组化特征比较分析

[目的]观察多房囊性肾细胞癌（MCRCC）免疫组化染色特征,并与透明细胞性。肾细胞癌（CCRCC）进行比较。[方法]收集10例MCRCC和12例低核级的CCRCC．应用免疫组化Envision方法检查常用的肾肿瘤诊断标志物CK7、CD10、P504s、Vimentin、EMA、Cam5．2和PAX8在两者之间的表达情况并进行比较分析。[结果]MCRCC中．80．0％表达CK7．40．0％表达CD10．30．0％表达P504s,50．0％表达Vimentin,100．0％表达EMA、Cam5．2和PAX8。CCRCC中,16．7％表达CK7．91．7％表达CD10．25．0％表达PS04s．58．3％表达Vimentin,100．0％表达EMA、Cam5．2和PAX8。MCRCC与CCRCC的免疫组化特征比较,CK7在前者的表达率明显较高（P〈0．05）,而CD10在前者的表达率明显较低（P〈0．05）。P504s、Vimentin、EMA、Cam5．2和PAX8等标志物在两者之间的表达率无明显差别（D0．05）。[结论]MCRCC是一种组织学上独特的低级别肾肿瘤,免疫组化染色特征虽不同于CCRCC．但两者之间存在明显的重叠,组织形态学特征是鉴别诊断两者最重要的标准．     

肾细胞癌保留肾实质手术的临床探讨

目的：探讨保存肾实质手术在肾细胞癌治疗中的临床价值。方法：1995年2月～2002年12月，对14例肾细胞癌病人施行保留肾实质手术，其中双侧肾癌3例，对侧肾有病变或潜在功能受损的肾癌5例，对侧肾功能正常的肾癌6例。肿瘤直径2．0～5．8cm，平均3．9cm。病理分期：T1期8例、T2期6例。9例行肾部分切除术，5例行肿瘤剜出术。结果：本组14例术后无并发症，随访13例，6个月～7年10个月，平均为50个月，1例术后3年发现肺转移，12例无瘤生存，本组均无肿瘤局部复发。1例失访。结论：根治性肾切除术是肾癌手术的金标准，而保留肾实质的手术一般只用于双侧肾癌及解剖或功能上的孤立肾肾癌患者。近年来，随着医学影像学的不断发展、外科技术的日益提高以及偶发肾癌病例的增加，选择保留肾实质的手术也日渐增多。保留肾实质手术是治疗局限性肾细胞癌患者的有效手段，能安全有效地保存肾功能，而手术效果与肾癌根治手术相当。     

Clear-cell Renal Cell Carcinoma: Molecular Characterization of IMDC Risk Groups and Sarcomatoid Tumors

IntroductionRecent trials have suggested predictive biomarkers in advanced clear-cell renal cell carcinoma (accRCC): International Metastatic RCC Database Consortium (IMDC) good risk or angiogenic gene signature for sunitinib and IMDC intermediate/poor risk for ipilimumab-nivolumab and T-effector cell signature or sarcomatoid dedifferentiation for atezolizumab-bevacizumab. We hypothesized that earlier described molecular subtypes, ccrcc1 to ccrcc4, could provide similar information as a single generic biomarker and molecularly characterize the heterogeneous intermediate-risk group.Patients and MethodsPatients with accRCC treated with systemic therapies were included. We assessed associations between the 5 biomarkers and their impact on progression-free survival (PFS) and response rate (RR) on first-line sunitinib or pazopanib. The cutoff percentage of sarcomatoid dedifferentiation with optimal discriminative value was determined.ResultsIn total, 430 patients were included (163 with molecular data). The molecular ccrcc2 subtype identified tumors with higher angiogenic gene expression across IMDC risk groups: prevalence was high in IMDC good risk and low in IMDC poor risk (P < .001). Molecular subtype, IMDC, and angiogenic gene expression had comparable C-indices to predict PFS and RR (range, 60%-66%). The ccrcc2 subtype and angiogenic gene expression were positive predictors of PFS in IMDC intermediate-risk patients (P = .006; P = .04). Immune signature did not differ between IMDC groups, but was strongly correlated with molecular subtype (P = .8 and P = .0007). A cutoff value of 25% sarcomatoid differentiation discriminated tumors with distinct molecular characteristics and therapeutic sensitivity.ConclusionIn accRCC, molecular subtypes can explain differences in IMDC risk group, expression of angiogenesis and immune response genes, and sarcomatoid dedifferentiation. They can identify molecularly different patient populations within the heterogeneous IMDC intermediate group and select patients for systemic therapies.     

肾癌的早期诊断：附小肾癌与无症状肾癌18例分析

１９６６年至１９８９年，我科收治肾癌１２５例，其中小肾癌１０例，无症状肾癌８例，对于小肾癌的影像学检查，我们体会，应该用Ｂ超，ＩＶＵ及ＣＴ进行联合影像学诊断，１０例小肾癌中，６例有血尿或腰疼，说明血尿及腰疼并不是肾癌的晚期症状，而也可以是肾癌的早期临床表现。８例无症状肾癌中，３例为Ｂ超查体发现，我们建议推广对４０岁以上中老年人Ｂ超查体，本文还提出了肾癌的狭义早期诊断及广义早期认断的两个新概念。     

Adjuvant Therapy of Renal Cell Carcinoma

Metastatic renal cell carcinoma (RCC) has a highly variable natural history and carries a dismal prognosis. Unlike many other tumors, RCC is generally unresponsive to cytotoxic, hormonal, and radiation adjuvant therapies after cytoreductive surgery. Different modalities of treatment have been tried and tested with modest success. Until recently, only immunotherapies such as interleukin-2 and interferon- α have been shown to provide a response, albeit in a minority of patients and often with severe treatment-associated toxicities. Other adjuvant therapies, such as active specific immunotherapy with Bacillus Calmette-Guerin and autologous renal tumor cell vaccines, have not provided alternative solutions. Recent approaches include heatshock protein peptide complex 96 vaccine and cG250 monoclonal antibody therapy. Novel targeted therapies have been developed using our knowledge of the molecular genetics that belie RCC. This culminated in sorafenib and sunitinib, the first Food and Drug Administration– approved drugs for RCC in more than a decade in the United States. The future will see further trials being carried out in the development of targeted therapies with emphasis placed on patient selection. Staging systems will need to be updated to integrate molecular biomarkers, which could potentially act not just as diagnostic and prognostic predictors, but also as tools for appropriate patient selection for treatment. In the future, this could potentially lead us to our ultimate goal of personalized medicine.     

High Occurrence of Non-Clear Cell Renal Cell Carcinoma in Oman

It is conventionally accepted that renal cell carcinoma (RCC) occurs in older patients and the clear cell type is the most common histology. However, ethnic variations exist and this study was carried out to determine the epidemiological pattern of RCC in Oman. Ninety RCC patients who presented to a tertiary care center in the Sultanate of Oman from 2010 to 2014 were studied. The main findings were that the median age of presentation was low, more patients presented with localized stage, and there was a higher incidence of non-clear (especially papillary) histology. Data from other Gulf countries and possible reasons for the different profile are discussed.     

Adjuvant Therapy for Renal Cell Carcinoma

In the past few years, several targeted therapies have been approved by the U.S. Food and Drug Administration for the treatment of advanced renal cell carcinoma. This has led to an improvement in the progression-free survival and quality of life for these patients. Nevertheless, the use of these and other therapies in the adjuvant setting has failed to demonstrate a clear benefit. Immune therapies and hormonal or targeted therapies have been studied in this indication, and there are clinical trials currently enrolling patients with high risk of relapse. This article reviews the available data and the ongoing trials exploring the role of adjuvant therapy for kidney cancer.     

肾细胞癌病理分类的新进展

文章简要介绍了2004年WHO推荐的最新肾癌病理分型及病理特点，结合临床简要介绍了各肾癌亚型的临床表现、影像学特点及预后。     

肾嫌色细胞癌的诊断和治疗

目的：探讨肾嫌色细胞癌的临床诊断和治疗方法。方法：3例肾嫌色细胞癌均经手术切除及光镜、免疫组化、Hale’s胶体铁染色和电镜检查。结果：Doppler超声和CT检查无特异性。病理组织学：肉眼观察肿瘤质地均一，呈淡棕色，肿瘤中央可有坏死灶；光镜下细胞大，胞浆呈纤细网状结构，胞界清楚；Hale‘s胶体铁染色阳性；EMA、CK19、Ckpan、Vimentin阳性，S－100阴性；电镜下胞浆内有大量膜性小囊泡。随访14．1－31个月（平均19．7个月），1例术后11个月肺部转移，2例无复发或转移，至今生存。结论：肾嫌色细胞癌在病理组织学、组织化学、免疫组化和电镜观察与其它肾癌有明显区别。手术切除是治疗首选方法。可能是一种低恶性潜能有较好预后的肿瘤。     

PET显像在原发性肾细胞癌中的研究进展

PET显像作为一种重要的功能影像学方法引起了人们广泛关注。^18氟-脱氧葡萄糖是目前最常用的正电子显像剂，但它在肾细胞癌诊断中存在一定缺陷。目前，一些新示踪剂：^18氟-氟胸腺嘧啶、^11碳-乙酸盐、”氟-硝基咪唑等已逐渐投入临床使用。     

Combined Chemo-Immuno-Hormonotherapy of Advanced Renal Cell Carcinoma

Summary

Thirty-five patients (pts.) with advanced renal cell carcinoma were treated with a combination of vinblastine (5mg/m²/IV) plus epirubicin (50mg/m²/IV) every 3-4 weeks, alpha-2-A-intcrferon (9 × 10⁶ U/IM 3 times in the 1st week, then 18 × 10⁶ U/IM 3 times weekly), and medroxyprogesterone acetate (2,000 mg/os/day plus 500 mg IM/week). Thirty-one patients were males and 4 were females with a median age of 63 years (range 35-73) and median performance status of 70% (range 50-90%). We observed nine partial remissions (26%) with median duration of 40 weeks (range 20-232 + ). Fifteen pts. had no change (43%) while 11 pts. progressed (31%). The main side-effects were: leukopenia (29/35, 83%) with median nadir of 3,100 WBC/mmJ (range 510-3,990) and fever (32/35, 91%). Thrombocytopenia occurred in 4 pts. (11%), anemia in 5 (14%), asthenia in 12 (34%), nausea/vomiting in 12 (34%), alopecia in 8 (23%) and stomatitis in 3 (8.5%). Two patients stopped the therapy with medroxyprogesterone acetate because of muscular cramps. Median survival was 65 weeks (range 6-327 + ). We conclude that the combination of recombinant alpha 2A-interferon-vinblastine-epirubicin and medroxyprogesterone acetate has modest but definitive activity in patients with advanced renal cell carcinoma.     

Surgical Treatment of Metastatic Renal Cell Carcinoma

The survivals of 174 patients who underwent nephrectomy forrenal cell carcinoma were analyzed to evaluate the influenceof the surgical treatment of metastases on their prognosis.For 34 of the 174 patients, surgical resections of the metastaseswere performed concurrently with nephrectomy. For 38 patients,44 surgical resections of metastases were performed in the follow-upperiod after nephrectomy. Apparently curative resections ofmetastases, at the time of nephrectomy or after nephrectomy,were significantly correlated with good survivals after surgery,irrespective of the number of metastatic foci. Aggressive surgicaltreatment was beneficial in patients with a longer tumor-freeperiod after nephrectomy or with stable disease for about sixmonths after surgical treatment, although this might simplybe a reflection of a longer natural disease course in this specificgroup of patients.     

肾细胞癌免疫治疗的研究进展

肾细胞癌（renal cell carcinoma, RCC）是成年男性常见的恶性肿瘤, 其发病率和死亡率排名均较前。免疫治疗能够激活机体免疫系统产生对肿瘤的反应使疾病稳定,但高剂量不良反应限制了其在临床的广泛应用。而靶向药物的兴起让肾癌患者治疗方式向靶向治疗转变。随着对肾癌临床治疗方式的不断深入研究,发现单纯的免疫或靶向治疗难以得到令人满意的疗效。因此有学者提出肾细胞癌的治疗应该向免疫联合靶向治疗方向转变。本文旨在对当前肾细胞癌相关免疫治疗的临床研究作一综述,以期为临床肾细胞癌的免疫治疗提供一定的理论依据。