肾癌97例临床分析

１９６３－１９９３年收治肾癌９７例，占同期肾肿瘤的７０．３％，结合文献对３０年来肾病的发病、诊断和治疗方法的变迁作了分析，并讨论了影响肾癌预后的诸因素。     

青年肾癌的临床及病理学特点

目的探讨青年肾癌的临床及病理学特点，提高对青年。肾癌的认识。方法回顺性分析1983年8月至2005年6月732例。肾癌患者资料，其中〈35岁患者35例，占4．8％。男22例，女13例。年龄19～35岁，平均31岁。临床表现无痛性血尿12例（34％）、腰痛12例（34％）、腹部包块2例（6％）、发热3例、Stauffer综合征1例。肿瘤育径1．2～13．8cm，平均6．0cm。AJCC分期：Ⅰ期8例、Ⅱ期4例、Ⅲ期18例、Ⅳ期5例。行根治性肾切除术28例（包括3例同时行腔静脉瘤栓取出术，1例腔静脉取瘤栓加肺叶切除术）、肾部分切除术5例、束手术2例。结果34例手术患者（其中1例仅行探查取活检）术后病理为透明细胞癌23例、混合犁细胞癌5例、乳头状细胞癌和嫌色细胞癌各2例、低分化及未分化细胞癌各1例。26例患者随诊12—148个月，平均56个月。术后3、5年生存率分别为65％、50％。结论青年肾癌早期痛状隐匿，缺乏特异性，易忽视，确诊时临床分期相对较晚，恶性程度相对较高，易引起组织浸润和远处转移，预后相对不良。     

肾癌369例临床分析

目的：提高肾细胞癌的诊治水平。方法：对369例肾细胞癌患者的发病、诊治和预后情况进行回顾性分析。结果：透明细胞癌281例（76．2％）,颗粒细胞癌39例（10．6％）,混合细胞癌42例（11．4％）,其它癌7例。行肾癌根治性切除术301例（81．6％）,其它方式手术45例,其中静脉癌栓取出术12例。随访297例,3、5、10年生存率分别为74．6％、56．2％和28．2％。结论：B超和CT是目前诊断肾细胞癌的重要手段,早期行根治性肾癌切除术仍是最有效的治疗方法,联合生物治疗对晚期和姑息性治疗病人有一定效果。     

肾癌525例临床分析

目的　探讨肾细胞癌的诊治方法。　方法　对 1 978年 1月至 1 997年 1 2月收治的肾细胞癌 5 2 5例资料进行分析。　结果　诊断以B超、CT为主。行肾癌根治性切除术 40 2例(76 .6 % ) ;其他类型手术 6 4例 ,其中探查术肿瘤无法切除 1 0例。病理结果 :透明细胞癌 32 1例 (70 .4% ) ,颗粒细胞癌 43例 ,混合型癌 77例 (1 7.0 % ) ,其它 1 5例。 40 2例 (76 .6 % )获得随访。 3年、5年和 1 0年生存率分别为 76 .7% (2 0 7/ 2 70 )、6 1 .6 % (1 2 2 / 1 98)和 2 7.2 % (2 5 / 92 )。　结论　早期发现、早期根治性肾癌切除手术仍是提高肾细胞癌生存率的关键。     

青年型肾癌56例报告

目的探讨青年型肾癌的临床特征及诊治措施。方法青年型肾癌56例。男36例,女20例。平均发病年龄32.4岁。偶发癌20例,症状癌36例。病程2 d～4年。临床症状有肉眼血尿18例、腰腹胀痛23例、消瘦乏力2例、发热3例、可触及肿块2例,其中有2项以上症状者12例。单侧55例,双侧1例。56例患者均行B超、CT检查,11例患者行KUB加IVU检查,2例行MR检查。50例行根治性肾切除,6例行保留肾单位手术。术后随访7～108个月,平均64个月。结果B超诊断错构瘤4例,多囊肾1例,肾脏炎性肿块1例,肾肿瘤50例;B超检出率89.3%。CT诊断为错构瘤2例,肾肿瘤54例;CT检出率96.4%。行MR检查2例,诊断肾肿瘤1例,错构瘤1例。9例有症状者行KUB加IVU检查,5例示肾集合系统受压,1例未显影,1例示肾盏破坏,2例示肾外形增大;2例偶发癌者行KUB加IVU检查均未见明显异常。20例偶发癌者肿瘤直径1.8～10.0 cm,平均4.8 cm;其中T1N0M0者16例,T2N0M0者3例,T3N0M0者1例。36例有症状者肿瘤直径2.5～13.0 cm,平均8.7 cm;其中T1N0M0者20例,T2N0M0者7例,T3N0M0者4例,淋巴结阳性者5例。偶发癌组20例中仅1例(T3N0M0)行根治术者于术后19个月肾窝复发,再次手术治疗,于术后53个月死于全身转移;偶发癌组的5年存活率为92.3%。症状癌组中8例因癌死亡,4例失访,5年存活率为66.7%。2组5年存活率比较差异有统计学意义(P=0.042)。结论青年型肾癌恶性程度与普通人群肾癌相仿,根治性肾切除是主要的治疗方式,合适的患者可行保留肾单位手术。     

遗传性肾癌11例临床分析

目的 探讨遗传性肾癌的诊断和治疗方法.方法 回顾性分析11例遗传性肾癌患者的临床资料,其中男8例、女3例,年龄32～67岁,平均48岁;4例为双侧肾癌,4例为多发肾癌.2例诊断为希佩尔-林道病综合征,6例诊断为家族性肾透明细胞癌,3例诊断为遗传性乳头状肾癌.10例患者行保留肾单位的手术和（或）肾癌根治术,1例未手术.结果 随访12～114个月,4例发生肿瘤复发,1例死于肿瘤转移,2例死于其他原因,4例无瘤生存.结论 遗传性肾癌发病年龄较早,肿瘤双侧、多中心发病率较高,应尽量行保留肾单位手术.     

索拉非尼治疗晚期肾癌33例临床分析

目的 初步评价索拉非尼治疗晚期肾癌的疗效和不良反应.方法 2007年5月至2009年6月应用索拉非尼治疗转移性肾癌33例.男23例,女10例.年龄21～81岁,中位年龄54岁.其中透明细胞癌29例,乳头状细胞癌2例,嫌色细胞癌和透明混合嫌色细胞癌各1例.单一脏器转移18例,多脏器转移15例,至少具有1处可测量病灶.其中发现肾癌同时伴有转移4例,术后发现转移29例,术后1年以内发现转移15例,＞1年14例.曾接受免疫治疗和(或)化疗13例,索拉非尼一线治疗20例.口服索拉非尼400～600 mg 2次/d,直至肿瘤进展或出现不可耐受的不良反应.采用实体瘤疗效评价标准每8周评定1次.随访11～106周,中位随访时间29周.结果 全组无完全缓解患者,部分缓解 4例(12%),疾病稳定27例(82%),疾病进展2例(6%),无死亡病例.最常见的不良反应是手足皮肤反应28例(85%)、腹泻15例(46%)、皮疹14例(42%)、脱发12例(36%)、口腔炎及溃疡6例(18%)、高血压2例(9%),3级腹泻1例(3%),未见4级毒副反应.结论索拉非尼治疗晚期肾癌有效率12%,疾病控制率94%.不良反应较轻,大多数患者可以耐受.

Abstract：

Objective To investigate the efficacy and toxicity of sorafenib in the treatment of advanced renal cell carcinoma. Methods From May 2007 to JUN 2009, 33 patients with advanced renal cell carcinoma were given oral sorafenib 400-600 mg twice daily. There were 23 males and 10 females in the study group. The pathological diagnosis of the primary tumors was clear cell carcinoma in 29 patients, papillary renal cell carcinoma in 2 patients, chromophobe renal cell carcinoma in 1 patient and chromophobe renal cell carcinoma mixed with clear renal cell carcinoma in 1 patient. Fifteen patients had multiple organ metastases and 18 patients had single organ metastasis. The median follow-up time was 29 weeks. Results Four (12%) patients achieved partial remission, 2 (6%) patients achieved progression disease, the remaining 27 (82%) patients achieved stable disease. Complete remission was not observed in the group. Two of the partial remission patients benefited on bone metastases. Common toxicities were skin reaction (85%), diarrhea (46%), erythra (42%), alopecia (36%), oral ulcer (18%) and hypertension (9%). Conclusions Sorafenib could be effective in controlling tumor growth. The overall effectiveness was 12%, the disease control proportion was 94% in this group and its toxicity was relatively minor and well tolerated.     

58例偶发性肾癌的临床分析

目的探讨偶发性肾癌的临床特征、诊治方法和影响预后的因素。方法回顾性分析偶发性肾癌58例，非偶发性肾癌146例，对两组肿瘤的分期、分级与预后进行比较。结果偶发性肾癌的病理分期明显低于非偶发组（P〈0.01）；而肿瘤病理分级及组织类型无显著性差异（P〈0.05）；术后3年、5年、10年的生存率分别为92．4％、83．6％和72．4％，明显高于非偶发性肾癌组（P〈0.05）。结论B超、CT的广泛应用提高了偶发性肾癌的检出率；病理分期低、肿瘤小、早期发现和及早的根治性切除是偶发性肾癌预后好的主要原因。     

囊性肾癌10例分析

目的：探讨提高囊性。肾癌的诊治水平的方法。方法：对10例囊性。肾癌的临床资料进行回顾性分析。术前CT诊断囊性。肾癌8例,复杂性。肾囊肿1例,单纯性。肾囊肿1例。10例均行根治性。肾切除术。结果：术后病理检查均为囊性。肾透明细胞癌,其中。肾癌囊性坏死5例,多房性囊性。肾癌2例,单纯性囊肿恶变3例。随访8例,7例术后生存至今,生存时间1个月～6年,1例术后6个月死于脑血管意外。结论：囊性。肾癌有其独特的临床、影像学及病理学特征,确诊者宜行根治性。肾切除。     

经腹腹腔镜肾癌根治术的临床分析

目的:探讨经腹腹腔镜肾癌根治术的临床应用价值。方法:选择肾癌患者196例,肿瘤直径3.5～8.2cm;左侧87例,右侧109例,86例肿瘤直径大于5.0cm,均行经腹腹腔镜肾癌根治术。结果:194例成功完成腹腔镜手术,2例中转开腹。手术时间60～180min,平均110min。术后无严重并发症发生,术后住院5～10d,平均7.2d。结论:经腹腹腔镜肾癌根治术安全有效,患者创伤小,康复快,具有良好的临床应用前景。     

肾嫌色细胞癌21例临床分析及文献复习

目的 提高肾嫌色细胞癌的诊治水平和对此类型肾癌的认识.方法 回顾性分析21例肾嫌色细胞癌的临床资料.男11例,女10例.年龄27 ～ 85岁,平均52岁.11例行腹腔镜下肾癌根治术,8例行腹腔镜下肾部分切除术,2例行开放肾癌根治术.结果 术后病理证实为肾嫌色细胞癌.病理分期:pT1N0M0 13例,pT2N0M0 5例,pT3aN1 M0 2例,pT4N0M0 1例.Fuhrman病理分级:G1 6例,G2 14例,G31例.术后随访19例,时间3～36个月,平均17个月,1例死于心脏病,1例术后6个月局部复发,给予索拉非尼治疗2个月后肺部感染死亡,1例术后12个月后出现肺转移,给予索拉非尼治疗1个月后死亡,16例无瘤生存.结论 肾嫌色细胞癌是一种具有特殊形态的少见肾癌类型.肾根治性切除术是治疗肾嫌色细胞癌的首选方法.与同期、同级的其他类型肾癌相比,肾嫌色细胞癌预后较好.     

Renal cell carcinoma: late recurrence in 2 cases.

We present 2 patients with late recurrence 16 and 11 years after nephrectomy for renal cell carcinoma. Metastases were solitary and their location very uncommon (vastus externo muscle and colon). In the reviewed series of 5,758 patients with renal cell carcinoma only a temporal muscle metastasis and another in the colon were observed but none of them was solitary.     

马蹄肾合并肾细胞癌3例报告

目的:提高马蹄肾合并肾细胞癌的认知水平。方法:报告3例马蹄肾合并肾细胞癌的临床表现、诊治过程及影象学特点。3例患者中,2例存在反复发生的泌尿系感染,2例合并结石,其中1例有明显的腰部绞痛病史。2例符合根治手术的病例行开放性根治性肾切除术。1例因存在远处转移而仅行生物治疗。结果:2例手术患者随访1年内,未发现肿瘤复发及转移。1例因放弃治疗而于半年内死于肿瘤转移。结论:对于符合根治手术条件的马蹄肾合并肾细胞癌患者,首选的治疗仍为根治性肾切除术。术前充分估计相应的变异血管,细致的腹膜后腔解剖,以及妥善处理峡部,是手术治疗的关键所在。     

Renal cell carcinoma in childhood and adolescence: a clinical and pathological study of 17 cases

From 1955 through 1984, 17 patients aged 17 years or younger were treated or seen in consultation for renal cell carcinoma at the Children's Hospital and Dana Farber Cancer Institute. There were 11 girls and 6 boys, with an average age at diagnosis of 11 years (range 4 to 17 years). Gross hematuria and abdominal or flank pain were the most common presenting complaints, and in 5 cases there was a history of antecedent trauma. The tumors ranged in size from 2 to 15 cm. (average diameter 7.5 cm.). There were 10 tumors in the left kidney and 7 in the right kidney. Childhood renal cell carcinoma displayed similar gross and microscopic features compared with counterparts in adults. The smallest renal cell carcinoma to metastasize measured 3 cm. in diameter and the pathological features suggested an origin from distal collecting tubules (ducts of Bellini). There were 6 tumor-related deaths (35 per cent over-all mortality) occurring 2 months to 2 years after diagnosis. Eleven children were well, with an average duration of followup of 12 years (range 4 to 27 years). The most important prognostic factor was clinical stage at the time of diagnosis. The presence of renal vascular invasion per se did not appear to be an adverse finding. The most optimal treatment for children with stage I renal cell carcinoma is radical nephrectomy with regional lymphadenectomy. While adjuvant radiation and/or chemotherapy may be used in patients with more advanced stage disease, their efficacy in achieving long-term survival free of relapse or cure is not well defined.     

Renal cell carcinoma in young compared to older patients: comparison of clinicopathological risk factors and survival

OBJECTIVE: Renal cell carcinoma (RCC) is primarily a disease of the elderly, most patients being diagnosed in their mid-60s. However, a significant number of patients are diagnosed at a younger age. The true effect of age at diagnosis on survival has been debated, tumor stage and grade being the strongest prognostic factors of survival. The aim of this nationwide study was to study the significance of young age at diagnosis as a prognostic factor in RCC. MATERIAL AND METHODS: This retrospective study included all living patients with histologically verified RCC in Iceland diagnosed between 1971 and 2000 (n = 629). Different clinicopathological factors of patients diagnosed aged < 50 years (n = 99) were compared to those of patients diagnosed aged > or = 50 years (n = 530). Disease-specific survival was compared and multivariate analysis was used to evaluate prognostic variables. RESULTS: Clinical presentation, TNM stage, grade, tumor size and histological subtypes were comparable between the two groups. Prognostic factors were the same in both groups, most of them having a stronger prognostic value in younger patients. Both 5- and 10-year disease-specific survival was significantly higher in the younger group (66.4% vs 54.5% at 5 years). CONCLUSIONS: The clinicopathological profiles are comparable in RCC patients aged < and > or = 50 years. The reason for the more favorable survival of younger patients is not known. Further studies are needed, including studies on possible differences in age-specific host-tumor response.