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。     

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     

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。     

63例Ⅰ~Ⅲ期肾细胞癌患者术后辅助治疗疗效及预后因素分析

目的研究肾细胞癌术后辅助治疗的疗效及影响患者远期生存的因素。方法回顾性分析63例肾细胞癌患者术后辅助治疗的效果,多因素分析影响生存期的因素。结果全组5年生存率为71.0%;病理分期Ⅰ、Ⅱ和Ⅲ期患者5年生存率分别87.7%、70.3%和42.9%（χ²=11.629,P=0.003）,T1、T2和T3期患者的5年生存率分别为88.7%、63.9%和37.0%（χ²=11.850,P=0.003）,N0和N1患者的5年生存率分别为78.0%和35.6%（χ²=8.599,P=0.003）,有、无静脉瘤栓的患者5年生存率分别为31.3%和76.0%（χ²=8.108,P=0.004）。全组局部复发率和远处转移率分别为15.9%（10/63）和23.8%(15/63)。多因素分析表明T分期（P=0.021）、N分期（P=0.040）、手术切除（P=0.032）、术后生物化疗（P=0.022）、术后放疗（P=0.042）是影响患者总生存期的独立预后因素。结论TNM分期是患者能否远期生存的决定性因素,术后辅助生物化疗和辅助放疗可提高总生存率,但需要进一步大样本随机对照研究。     

三种手术方式对复杂性肾透明细胞癌的疗效对比

目的 分析3种手术方式对复杂性肾透明细胞癌的治疗效果并进行比较。方法 收集78例复杂肾细胞癌(T1N0M0,透明细胞癌)患者,分为开放根治性肾切除术(腹腔镜组)(22例)、开腹NSS组(32例)和腹腔镜NSS组(24例)。随访3年,比较临床疗效。结果 开腹NSS组的平均手术时间和缺血阻断时间与腹腔镜组相当,明显短于腹腔镜NSS组(P<0.05)。开腹NSS组切除肿瘤直径与腹腔镜NSS组相近,明显小于腹腔镜组(P<0.05)。腹腔镜组阳性切缘率明显低于腹腔镜NSS组,开腹NSS组总并发症发生率与腹腔镜NSS组相当,明显低于腹腔镜组,手术成功率明显高于腹腔镜NSS组(P<0.05)。腹腔镜组75%患者生存时间>30.0个月,开腹NSS组75%患者生存时间>35.0个月,腹腔镜NSS组75%患者生存时间>34.0个月,差异有统计学意义(P<0.05)。开腹NSS组和腹腔镜NSS组的死亡率相当且明显低于腹腔镜组(P<0.05)。结论 开腹NSS治疗复杂肾细胞癌比腹腔镜组和腹腔镜NSS治疗更安全有效。     

儿童及青少年肾细胞癌的治疗和预后

肾细胞癌(renal cell carcinoma,RCC)是儿童及青少年人群中不常见的恶性肿瘤,因而在此话题上进行过的调查和证据相对较少。近几年关于儿童及青少年RCC的研究主体已取得一些进展,其与更为普遍的成人型RCC的重要不同日益明显。为了解青少年儿童RCC治疗及预后与成人RCC相比的不同之处,以及尽可能的对基于此的评估和处理提出建议,作者使用Pub Med进行对青少年儿童RCC的治疗及预后相关文章的彻底搜索、列表及探讨。发现大多数青少年儿童RCC案例显示出肿瘤移位症状,这有可能最终解释先前许多关于青少年儿童RCC的不同点的观察数据。然而,移位病状与临床处理的关联性尚有不明之处,因而大多数情况下继续以对待常规肿瘤亚型患者的方法来治疗,因此需要更大规模的临床研究进行探索,找到针对儿童及青少年RCC的个体化治疗方案。     

白细胞介素6和肾细胞癌

ＩＬ－６是一种多能细胞因子，在许多肿瘤有高水平表达，近来发现ＩＬ－６是肾细胞癌细胞的自分泌生长因子，在肾细胞癌细胞的生长调节中起重要作用。肾细胞癌及转移性肾细胞癌病人中均有高水平ＩＬ－６表达，表达水平与肿瘤转移和预后关系密切。针对ＩＬ－６高表达的治疗已显示初步成效，但需进一步发展完善。     

乳头状肾细胞癌的临床病理特征及预后

目的 探讨乳头状肾细胞癌(PRCC)的临床病理特点、免疫表型和预后.方法 回顾性分析19例PRCC患者的临床和病理资料,对肿瘤组织进行免疫组化染色并鉴定其免疫表型,对患者进行随访.结果 PRCC临床上症状多不明显,常在体检时发现.光镜下PRCC组织主要由多少不等的乳头状和管状结构组成,被覆单层立方或多层柱状肿瘤细胞,乳头轴心及间质内可见泡沫细胞、砂粒体沉积,部分肿瘤细胞胞浆内可见含铁血黄索.Ⅰ型12例,Fuhrman核分级均为1～2级;Ⅱ型7例,其中5例Fuhrman核分级为3～4级.Ⅰ型和Ⅱ型PRCC不同程度地表达vimentin、EMA、CKpan、CK7、CD10和p504s,但均不表达34βE12和CK20.16例获得随访的患者中,3例分别于术后3、8和9个月死于肿瘤转移,且均为Ⅱ型PRCC;2例死于其他疾病;其余11例患者均为无瘤生存.结论 PRCC的两种亚型在形态学、免疫表型和预后上有差别,与Ⅰ型PRCC比较,Ⅱ型较Ⅰ型预后不良.PRCC细胞核分级高、出现肉瘤样成分或有透明细胞癌结构可能提示肿瘤具有侵袭性,预后不良.     

围手术期感染对肾细胞癌切除术后肿瘤特异性生存期的影响

目的 探讨围手术期感染对肾细胞癌切除术后肿瘤特异性生存期(CSS)的影响。方法 以青岛大学附属医院2006年1月—2013年1月收治的1 800例肾癌患者为研究对象,分析肾癌切除术后30 d内发生感染的情况。用Kaplan-Meier曲线分析感染与未感染患者的CSS;建立Cox比例风险模型来评估感染对CSS的影响时控制性别、年龄、AJCC分期和分级、肿瘤大小、病理学类型、合并症、手术方式和系统治疗等因素。结果 1 800例患者中位年龄74岁(69~79岁),中位随访时间为42个月(22~67月)。严重感染者141例,非严重感染者296例,未感染者1 363例。Kaplan-Meier分析结果显示,严重感染有改善肾癌(肿瘤直径为7.0~9.9 cm)患者CSS趋势(P=0.048);对于肿瘤直径≥10 cm或＜7 cm的患者,严重感染对CSS无影响(0.1~3.9 cm,P=0.120;4.0~6.9 cm,P=0.768;≥10 cm,P=0.412)。多因素Cox回归分析结果显示,严重感染可以改善肾癌患者的CSS(HR=0.752,P=0.032)。这种效应在肿瘤直径≥7 cm的患者中较为明显(P=0.041),而在肿瘤直径＜7 cm的患者中表现得不明显(P=0.268)。结论 围手术期严重感染可以改善肿瘤直径7~10 cm的肾癌患者CSS,但是对肿瘤直径≥10 cm或＜7 cm肾癌患者的CSS无明显影响。     

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。     

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。     

Renal Function Impairment Below Safety Limits Correlates With Cancer-specific Mortality in Localized Renal Cell Carcinoma: Results From a Single-center Study

BackgroundA recent multi-center study showed how estimated glomerular filtration rate (eGFR) and cancer-specific mortality (CSM) are linearly and inversely related in organ-confined renal cell carcinoma (RCC) whenever the eGFR decreases below specific thresholds. We addressed our previous work limitations related to heterogeneity and missing data, and explored the relationship between eGFR and CSM also in locally advanced RCC.Materials and MethodsAll patients with RCC treated with either partial or radical nephrectomy from 1990 to 2018 at a single institution and with complete data on renal function were included. eGFR was managed as a time-dependent variable. The relationship between eGFR and CSM was analyzed using a Fine and Gray multivariable competing risks framework. Subdistribution hazard ratios (SHRs) were calculated accounting for deaths from other causes.ResultsMultivariable competing risks analysis showed a “piecewise” relationship between eGFR and CSM, with an inverse linear correlation for eGFR values below 85 mL/min. Below this breakpoint, a significant relationship existed between eGFR and CSM in both clinical (SHR, 1.27; P < .001) and pathologic (SHR, 1.27; P = .001) models in stage I to II RCC subgroup. Conversely, no significance was recorded in this subgroup when considering eGFR values above 85 mL/min. In the stage III to IV subgroup, no significant relationships were recorded, regardless of eGFR values. The retrospective design with inherent biases in data collection represents a limitation.ConclusionsIn patients undergoing surgery for stage I to II RCC, preservation of renal function over “safety limits” is protective from CSM.     

Prognosis in Renal Cell Carcinoma: Analysis of Clinical Course following Nephrectomy

The clinical courses and survivals of 159 patients who underwentnephrectomy for renal cell carcinoma are reviewed. A longerdiseae-free period after nephrectomy was correlated with significantlybetter survival. Among patients in whom metastases in the lungsor bones were detected after nephrectomy, those with betweenone and five pulmonary or solitary bone metastases, wihtoutdefinite increases in their number and size in the six monthsfollowing their first appearance, survived significantly longerthan patients with a similar number of metastases but whichdid increase in number and size in the following six months,or patients with six or more pulmonary or multiple bone metastases.Even when metastases detected after nephrectomy were confinedto the lungs or bones throughout the observation period, thepatients did not necessarily show significantly better survivalsthan patients with metastases detected in multiple sites.     

后腹腔镜根治性肾切除术治疗局限性肾癌的疗效研究

目的 研究后腹腔镜根治性肾切除术(laparoscopic radical nephrectomy,LRN)治疗局限性肾癌的效果及安全性.方法 选择局限性肾癌患者80例,分为LRN组39例和传统开放肾癌根治术(open radical nephrectomy,ORN)41例(ORN组),比较两组的临床疗效.结果 与ORN组相比,LRN组手术时间、住院时间、术后肠功能恢复时间、术中出血量、白细胞、C-反应蛋白、肌酐和尿素氮均明显降低(P<0.05);LRN组的切口感染、术后出血、深静脉血栓形成、肺部感染、气胸、泌尿系统感染等并发症发生率为12.82%,明显低于对照组的29.27%(P<0.05);随访3~30个月,LRN组有1例术后5个月出现双肺转移,经口服索拉非尼后,现在病情已平稳;ORN组有1例术后4个月出现双肺转移,2例术后1年出现肿瘤全身转移.结论 后腹腔镜根治性肾切除术治疗局限性肾癌安全、有效,与传统开放手术相比,具有术后恢复快、创伤小、并发症少等优点,临床应用价值更高.     

Low Expression of ATM Indicates a Poor Prognosis in Clear Cell Renal Cell Carcinoma

IntroductionThe study was carried out to examine the expression of ataxia telangiectasia mutant (ATM) of clear cell renal cell carcinoma (ccRCC), and to explore the relationship between the expression of ATM and the clinicopathologic parameters and prognosis of ccRCC.Materials and MethodsClinicopathologic data of the patients with ccRCC were collected from January 2011 to August 2015 in Xiangya Hospital, Central South University. The immunohistochemical method was used to detect the expression of ATM in ccRCC and adjacent tissues. The Kaplan-Meier survival method and log-rank test were used to analyze the relationship between ATM expression and the survival time of the patients with ccRCC. Univariate and multivariate Cox regression analysis was used to evaluate the risk factors for the prognosis of ccRCC.ResultsA total of 110 patients were selected in this study, including 73 men and 37 women. The expression of ATM in ccRCC is significantly lower than that in adjacent tissues. Further analysis found that the expression of ATM in the ccRCC tissues above grade II was lower than that of grade II or below. Kaplan-Meier survival analysis showed that the total survival time of the ATM low expression group was significantly shorter than that of the ATM high expression group. The multivariate Cox regression analysis showed that expression of ATM and clinical stage were independent factors affecting the prognosis of ccRCC.ConclusionATM expression level could serve as an independent risk factor for the prognosis of ccRCC and could be considered as a potential therapeutic target of ccRCC.     

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.     

双侧散发性肾癌患者的治疗和预后分析

目的：分析双侧散发性肾癌患者的临床疗效和生存状况。方法选择42例双侧散发性肾癌患者作为研究对象,行双侧肾手术治疗者29例,单侧手术治疗者8例,未进行手术治疗者5例,采用WHOQOL-100量表做为评估患者生存质量的标准。结果患者3年生存率为83．3％,双侧肾手术治疗与未行双侧肾手术治疗3年生存率分别为93．1％和61．5％,差异具有统计学意义（P＜0．05）;单因素分析结果显示：淋巴结转移、TNM分期及手术方式与患者预后相关（P＜0．05）,Cox多因素回归分析结果显示：手术方式及TNM分期是影响患者预后的独立风险因素;行双侧肾脏手术者WHOQOL-100量表躯体功能、心理状态、独立性及总生活质量评分均显著优于未行双侧肾手术治疗者（P＜0．05）。结论双侧散发性肾癌患者的治疗应以双侧保留肾单位的肾切除术为主,手术方式及临床分期是影响患者预后的独立风险因素。