肾细胞癌50例术后放疗分析

1977年～ 1990年共收治肾细胞癌术后放疗病人 5 0例 ,其 3,5 ,10年生存率分别为 6 0 .0 %、5 1.1%和 31.8%。 5年生存率 : ～ 期为 6 9.2 % , ～ 期为 4 3.8% ,与单纯手术相比术后放疗可提高患者 5年生存率。放疗应注意保护重要脏器 ,注意时间、剂量、分次设计 ,以免发生严重放疗并发症。区域淋巴结转移、肾周围器官侵犯和肾或腔静脉癌栓是预后不良因素 ,尤以前二者更为明显。本组病例83.3%死于远地转移 ,肺转移最多见占 5 8.3% ,其次是骨转移占 2 5 .6 % ,提示需寻找新的综合治疗方案解决远地转移问题。     

≤4cm肾细胞癌手术方式和预后比较

目的：探讨≤4cm肾细胞癌患者的手术方式和预后特点。方法：分析1992年1月至2002年12月诊断为肾细胞癌的75例患者的临床表现、手术方式和预后生存。结果：75例≤4cm的肾细胞癌患者均行手术治疗，其中50例（66．7％）为偶发性肾癌，有症状的25例（33．3％）。19例（253％）行肾部分切除术，56倒（74．7％）行肾癌根治术。肿瘤大小中位数为3．2cm（1．2-4cm）。平均随访时间60个月（1～1J8个月），肾部分切除术和肾癌根治术的5年生存率分别为95．4％。84．7％、5年肿瘤特异生存率为100％．结论：对于≤4cm的局限性肾细胞癌，无论是肾部分切除术或肾癌根治术．都有良好的预期生存.     

肾细胞癌术后放疗疗效分析

目的：探讨并分析肾细胞癌术后放疗价值及治疗失败原因。方法：1988年1月～1992年3月收治43例肾细胞癌术后病人，单纯手术22例，手术加术后放疗21例，放疗剂量50Gy／SW左右。结果：单纯手术者五年生存率为43．5％，手术加术后放疗者五年生存率为47．6％，两者比较无明显差异（P＞0．05）。单纯手术组死于远地转移者占66．7％（10／15，除外Ⅳb期7例），手术加术后放疗组死于远地转移者占66．7％（14／21），两者无显著差异（P＞0．05）。结论：远地转移为肾细胞癌治疗失败的主要原因，需寻找新的综合治疗手段解决远地转移问题。     

肾细胞癌55例临床分析

1980年1月～1989年12月,本科共收治肾占位病变99例,其中经手术后病理检查及其它临床手段证实肾细胞癌55例,占55.6%,列同期以肾占位病变入院病人的首位。现报告如下。临床资料本组男33例,女22例,男女之比为1.5:1;左侧28例,右侧26例,双侧1例。年龄22～74岁,50～60岁35例,占63.6%,平均年龄52.8岁。1、主要临床表现:主要症状及体征是血尿,疼痛及包块。其中血尿25例(45.5%),疼痛24例(43.6%),包块22例(40.0%)。比较前后5年临床表现,血尿由前5年的60%下降至后5年的42.2%,包块由61.2%降至     

肾细胞癌患者手术治疗的预后分析

目的：研究肾细胞癌患者根治性手术的独立预后因素。方法回顾性分析行肾细胞癌根治术患者482例的临床资料。结果患者因素当中的肿瘤发现方式和身体状态是患者术后的独立预后因素。肿瘤因素中的静脉浸润和渗透方式是独立的预后因素。是否使用α干扰素辅助治疗与患者生存率无显著相关性。身体状态、静脉浸润、渗透方式及组织学分级是独立的预后因素。结论身体状态、静脉浸润、渗透方式及组织学分级为肾细胞癌患者根治性手术后的最重要的独立预后因素。     

偶发性肾细胞癌29例诊治报告

目的 通过回顾性分析提高偶发肾癌的诊治水平。方法 回顾性分析本院29例偶发肾癌的诊治及预后。结果29例中按Robson分期为I期17例，Ⅱ期10例，Ⅲ期2例；21例行开放性肾癌根治术，8例行腹腔镜下肾癌根治术。其中28例至今仍健在，平均生存35个月。偶发肾癌生存时间高于症状性肾癌，其分期较低。结论 定期B超检查是早期发现偶发肾癌的重要手段。肾癌根治术是最有效的方法。腹腔镜肾癌根治术适合于早期肾癌。其预后主要取决于早期诊治。     

自体DC-CIK细胞治疗晚期肾细胞癌的疗效

目的：探讨自体树突状细胞（dendritic cell,DC）激活的细胞因子诱导的杀伤（cytokine-induced killer,CIK）细胞在晚期肾细胞癌（renal cell carcinoma,RCC）治疗中的临床效果与安全性。方法：采集22例2011年7月至2012年6月期间南京医科大学附属苏州医院肿瘤内科收治的22例RCC Ⅳ期患者\[男性12例、女性10例,中位年龄60.8岁（21~79岁）\]外周血单个核细胞（peripheral blood mononuclear cell,PBMC）,体外制备成DC-CIK细胞。流式细胞术分析DC-CIK细胞中CD3+T、CD8+T、CD4+T、NK（CD3-CD56+）和NKT（CD3+CD56+）细胞的比例,MTT法检测DC-CIK细胞对白血病K562细胞（对NK细胞敏感）和肾癌786-0细胞（对NK细胞不敏感）的杀伤活性。受试患者于常规治疗（手术+化疗+放疗/细胞因子治疗）结束后4周进行DC-CIK细胞治疗,每次静脉回输细胞数约（5.0±0.5）×108个,5次为1疗程,共3个疗程,分别于疗程开始前与结束后1周内监测患者外周免疫学指标（淋巴亚群、细胞因子谱）,严密观察并记录治疗过程中的不良反应。结果：DC-CIK细胞组成为CD3+细胞占（86.92±5.32）%、CD3+CD8+CD56+（NKT细胞）占（52.04±7.33）%、CD8-CD56+（NK细胞）占（785±315）%,DC-CIK细胞对786-0细胞和K562细胞的体外杀伤率相仿（效靶比为3∶1时,杀伤率分别为（16.5±1.7）%和（18.4±1.9）%,P=0.014）。患者接受DC-CIK细胞治疗后,外周血淋巴细胞亚群（CD3+T、CD4+T、CD8+T、CD3-CD56+NK细胞）比例无显著变化（P>0.05）;外周血中IL-2、IL-12和IFN-γ细胞因子水平较治疗前明显提升（均P＜0.05）,而TNF-α 和IL-10变化不明显（均P＞0.05）。2例患者发生一过性发热,持续4~6 h恢复,1例出现短期乏力。结论：DC-CIK细胞体外能有效杀伤786-0细胞和K562细胞。 输注后可提升部分RCC患者免疫水平,安全性良好,可作为晚期RCC患者辅助治疗之一。     

肾透明细胞癌口唇转移1例报告

患者,男,56岁,4年前因“间歇性全程肉眼无痛性血尿7天”在山东医科大学附属医院诊断为左肾癌,于1998年11月27日行左肾癌根治术,术后病理:左肾透明细胞癌。术后进行了预防性放、化疗。十个月前患者无诱因出现间歇性憋喘,并咳少量白痰,行胸部CT检查示:左肺门、纵隔及双肺转移癌。遂入我院行姑息性全身化疗,方案为:CF+5-Fu联合干扰素及白细胞介素-2。化疗期间无意中发现上唇正中一米粒大小肿物,色暗红,初考虑为毛囊炎,未行处置。该丘疹逐渐生长但速度较慢,三个月后约0.5cm×0.5cm大小,触之较硬,表面凸凹不平,其基底部与口唇较固定且无明显分界,考虑可能为恶性肿瘤并给予手术     

青年人肾细胞癌15例临床分析

青年人肾细胞癌(简称肾癌)较为少见.我们自1980年1月～1995年1月共收治青年人肾癌15例,现就其临床特点分析如下:1 临床资料本组男8例,女7例,年龄16～30岁,平均25.3岁.肿瘤位于左侧6例,右侧9例.病程最短者1个月,最长者4年.前10年发病者5例,后5年发病者10例.临床表现:血尿9例(60.0%),腰痛11例(73.3%),包块9例(60.0%).有典型三联征者4例(26.7%).肾外表现:贫血8例(53.0%),血沉增快10例(66.7%),发热3例(20.0%),高血压、肝功能异常、红细胞增多各1例.l例无任何症状,为体检时经B超检查发现.诊断主要依靠B超、IVP、CT、MRI及肾动脉造影检查.15例术前获得确诊.但有4例入院前曾被误诊为肾结核、肾盂肾炎及肾结石.根据Robson分期:I期3例,Ⅱ期4例,Ⅲ期2例,     

恶性胶质瘤术后治疗疗效及预后因素分析

目的观察恶性胶质瘤术后治疗的疗效,并分析其预后影响因素。方法恶性胶质瘤59例,其中Ⅲ级24例,Ⅳ级35例,术后给予三维适形放疗,肿瘤剂量50～60 Gy/5～6周。13例患者行同步化疗,替莫唑胺75 mg/m2.d。按照WHO实体瘤疗效评价标准评估疗效。采用Kaplan-Meier法计算生存率,Cox模型进行多因素分析。结果近期有效率（CR＋PR）为75.5%。全组病例1、3、5年生存率分别为52.5%（31/59）、27.1%（16/59）、10.1%（6/59）。单因素分析显示预后相关因素有年龄、病理分级、病变个数、手术切除程度、放疗前ECOG评分、手术至放疗开始的时间、同步化疗（P〈0.05）。多因素分析显示手术切除程度、同步化疗是独立预后因素（P〈0.05）。放疗期间23.7%的患者脑水肿加重。结论恶性胶质瘤术后放化疗疗效较好,手术切除程度和同步化疗是重要的预后影响因素。     

无症状肾癌：附10例报告

自１９９１年９月至１９９４年５月，由Ｂ超检查发现了１０例无症状肾癌患者。所有患者均行根治性肾癌切除术，术后随访２～３４个月，平均随访１９个月。１例术后３个月发现腰椎转移，局部放疗后带瘤存活至今，其余患者均无瘤健在。在临床中广泛应用Ｂ超检查能发现无任何临床症状的肾癌患者，今后如进一步扩大普查范围，则可发现更多此类患者。     

Treatments,Outcomes, and Validity of Prognostic Scores in Patients With Sarcomatoid Renal Cell Carcinoma: A 20-Year Single-Institution Experience

Introduction

Metastatic renal cell carcinoma (RCC) with a sarcomatoid component is a rare disease associated with a poor prognosis. We report the outcomes of 47 patients with metastatic sarcomatoid RCC (SRCC) treated with different modalities including chemotherapy, tyrosine kinase inhibitors, or immunotherapy over 2 decades in a French cancer center. Furthermore, we assessed the validity of prognostic scores in this subset of RCC.

囊性肾癌29例诊治分析

目的加深对囊性肾癌的认知,以提高囊性肾癌的诊治水平。方法回顾性分析29例囊性肾癌患者的流行病学、病理学、临床表现、影像学特征及临床治疗资料。结果囊性肾癌无特征性临床表现,术前影像学检查可以提供诊断线索;29例经病理检查确诊为肾癌囊性变19例,多囊性肾癌7例,单纯性囊肿癌变3例。19例行根治性肾切除术,10例行肾部分切除术。术后27例获得随访,生存时间平均为68个月(4～204个月不等)。结论囊性肾癌是一类在影像学和大体病理上具有囊性改变的肾癌的统称,有3种病理学类型,术前鉴定各亚型是选择手术方式和预后判断的关键。     

Factors Prognostic for Survival in Japanese Patients Treated with Sunitinib as First-line Therapy for Metastatic Clear Cell Renal Cell Cancer

Background: Factors predictive of survival have been identified in Western patients with metastatic clearcell renal cell carcinoma (mCCRCC) treated with sunitinib. Less is known, however, about factors predictiveof survival in Japanese patients. This study evaluated factors prognostic of survival in Japanese patients withmCCRCC treated with first-line sunitinib. Materials and Methods: This retrospective study evaluated 46consecutive Japanese mCCRCC patients treated with sunitinib as first line therapy. Clinical and biochemicalmarkers associated with progression-free survival (PFS) were analyzed, with prognostic factors selected by uniandmultivariate Cox regression analyses. Results: Univariate analysis showed that factors significantly associatedwith poor PFS included Memorial Sloan-Kettering Cancer Center poor risk scores, International MetastaticRCC Database Consortium poor risk and high (>0.5 mg/dl) serum C-reactive protein (CRP) concentrations(p<0.001 each). Multivariate analysis showed that high serum CRP was independently associated with poorerPFS (p=0.040). Six month disease control rate (complete response, partial response and stable disease) in responseto sunitinib was significantly higher in patients with normal (≤0.5 mg/dl) than elevated baseline CRP (p<0.001).Conclusions: CRP is a significant independent predictor of PFS for Japanese patients with mCCRCC treatedwith first-line sunitinib. Pretreatment CRP concentration may be a useful biomarker predicting response tosunitinib treatment.     

Real-world Effectiveness and Safety of Pazopanib in Patients With Intermediate Prognostic Risk Advanced Renal Cell Carcinoma

IntroductionThe objective of this study was to determine the effectiveness and safety of pazopanib in patients with intermediate-risk advanced/metastatic renal cell carcinoma in the PRINCIPAL study (NCT01649778).Patients and MethodsPatients had clear-cell advanced/metastatic renal cell carcinoma and met intermediate-risk International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) and Memorial Sloan Kettering Cancer Center (MSKCC) criteria. Assessments included progression-free survival, overall survival, objective response rate, and safety. We also evaluated effectiveness based on number of risk factors, age, and performance status (PS), as well as safety in older and younger patients.ResultsThree hundred sixty three and 343 intermediate-risk MSKCC and IMDC patients were included, respectively. The median progression-free survival was 13.8 months (95% confidence interval [CI], 10.7-18.1 months) and 7.4 months (95% CI, 6.2-10.3 months) for patients with 1 and 2 MSKCC risk factors, respectively, and 13.1 months (95% CI, 10.7-18.1 months) and 8.1 months (95% CI, 6.4-10.7 months) for patients with 1 and 2 IMDC risk factors, respectively. The median overall survival was not reached and was 15.2 months (95% CI, 12.3-26.5 months) for patients with 1 and 2 MSKCC risk factors, respectively, and 33.9 months (95% CI, 33.9 months to not estimable) and 19.4 months (95% CI, 14.3 months to not estimable) with 1 and 2 IMDC risk factors, respectively. A lower overall response rate was observed with Eastern Cooperative Oncology Group PS ≥ 2 (vs. PS < 2). All-grade treatment-related adverse events occurred in approximately 63% of patients, and the safety profile among older and younger patients was similar.ConclusionsOutcomes with pazopanib in intermediate-risk patients suggest that patients can be further stratified by number of risk factors (1 vs. 2) and Eastern Cooperative Oncology Group PS (< 2 vs. ≥ 2) to more accurately predict outcomes.     

Differing Risk of Cancer Death Among Patients With Pathologic T3a Renal Cell Carcinoma: Identification of Risk Categories According to Fat Infiltration and Renal Vein Thrombosis

ObjectivesThe study objectives were to evaluate the prognostic impact of fat infiltration and renal vein thrombosis in patients with pT3a renal cell carcinoma (RCC) and to identify new prognostic groups.Material and MethodsWe analyzed 122 consecutive patients with pT3a who underwent radical nephrectomy for RCC between 2000 and 2011 at the University of Bologna. Cancer-specific survival (CSS) rates were estimated using Kaplan–Meier survival curves; univariable and multivariable analyses were performed with Cox analysis.ResultsThe mean follow-up was 41.7 ± 35.4 months. Patients with peritumoral/hilar fat infiltration (n = 63) and patients with renal vein thrombosis (n = 18) experienced comparable CSS rates, whereas patients with both fat infiltration plus renal vein thrombosis (n = 41) showed worse survival outcomes than the first group (P = .026). Patients were divided in 2 groups: group A, with fat invasion or renal vein thrombosis, and group B, with concomitant fat invasion and renal vein invasion. Group B showed worse cancer-specific survival than group A (P = .024). At multivariate analysis, this new risk-group stratification was found to be an independent prognostic predictor of CSS (P < .05).ConclusionsPatients with T3a RCC with both fat invasion and renal vein thrombosis experience worse survival rates when compared with those patients with only 1 prognostic factor. The TNM classification should consider the concomitant presence of those parameters as a different prognostic predictor.     

肾癌细胞Ki-67免疫组化染色指数与预后的关系

 为探索肾癌预后较好的估价指标，41例肾癌根治标本Ki—67免疫组化染色。复发组的Ki—67染色指数显著高于未复发组（P相似文献   

部分切除术与根治术治疗pT1bN0M0期肾癌的临床疗效对比

目的 比较肾癌部分切除术（partial nephrectomy, PN）和肾癌根治术（radical nephrectomy, RN）治疗pT1bN0M0期肾癌的临床疗效及预后评估,为pT1b期肾癌的治疗选择提供参考。方法 回顾性研究湖北省肿瘤医院从2004年1月至2010年12月诊断为pT1bN0M0的肾癌患者（PN=16例,RN=52例）。比较两组之间的5年总生存率（overall survival, OS）,5年无复发生存率（recurrence-free survival, RFS）,和5年癌症特异性生存率（cancer-specific survival, CSS）。同时收集了术前和术后肌酐和肾小球滤过率（estimated glomerular filtration rate, eGFR）以评价肾功能的改变。结果 PN与RN的5年OS（90.3% vs. 88.6%, P=0.552）、RFS（90.3% vs. 75.4%, P=0.121）和CSS（90.3% vs. 92.8%, P=0.875）方面差异均无统计学意义。而术后肾功能下降患者所占比例在PN组显著优于RN组（0 vs. 12.6%, P<0.01）。术后一年血肌酐和eGFR水平在RN组中要高于PN组 [（0.3±0.6）vs.（0.2±0.1）、（20.1±12.6）vs.（9.8±12.1）],但是差异无统计学意义（P=0.115, P=0.064）。结论 PN或RN对于pT1bN0M0期肾癌的治疗在预后和安全性方面差异均无统计学意义,PN术后肾功能指标显著优于RN,PN是治疗pT1b期肾癌的一个可行方案。