临床诊断为局限性肾癌病例中区域淋巴结转移情况分析

目的分析临床诊断为局限性肾癌病例中区域淋巴结转移情况。方法回顾性研究1999年10月至2007年12月267例诊断为局限性。肾癌患者的资料。所有患者均通过CT扫描确定术前分期，采用AJCC2002年制定的TNM分期系统进行分期。分析术后病理证实有淋巴结转移患者的临床病理资料的特点及预后。结果267例临床诊断为局限性肾癌病例中有6例术后病理证实有区域淋巴结转移，其中T1aN1M0 1例，T1bN1M0 1例，T2N1M0 3例，T2N2M0 1例。6例均为透明细胞癌；核分级Ⅱ级1例，Ⅲ级1例，Ⅳ级4例；肿瘤直径4-10cm（平均7.7cm）；均为中央型肿物。清扫区域淋巴结后5例患者无瘤生存，1例于术后18个月死于复发转移。结论临床诊断为局限性肾癌病例病理证实为淋巴结转移者，多为高级别、中央型、体积较大的肾癌，区域淋巴结清扫后多数能无瘤生存。

Regional lymph node metastasis in clinical localized renal cell carcinoma

Objective To evaluate the incidence of regional lymph node metastasis in clinical localized renal cell carcinoma（RCC）. Methods 267 localized renal cell carcinoma patients admitted between October 1999 and December 2007 were analyzed retrospectively. The clinical stages were evaluated using CT scan according to 2002 AJCC TNM stage system. The clinicopathological character and prognosis of patients with lymph node metastasis were analyzed. Results Of 267 cases,6 were found with regional lymph node metastasis,including 3 T2N1M0,1 T1aN1M0,1 T1bN1M0 and 1 T2N2M0 in staging;All these 6 cases were clear cell RCC in pathology,of which there were 1 grade Ⅱ,1 grade Ⅲ,4 grade Ⅳ cases in nuclear grading. The diameters of tumors ranged from 4-10 cm （mean 7.7 cm）. All of the masses were localized centrally. 5 patients achieved cancer-free survival within follow-up after regional lymphadenectomy,and other 1 case died of recurrence and metastasis. Conclusions The localized RCC with regional lymph node metastasis were usually characterized by high grade,large size,central or the whole kidney involved. Most of these kind patients may achieve cancer-free survival after regional lymphadenectomy.