上海仁济医院肾癌数据库资料分析

目的 探讨肾癌临床、病理、分期、分级与预后特征. 方法 分析2003年至2005年上海仁济医院泌尿科肾癌数据库435例患者临床和病理资料.采用WHO 1997年肾实质上皮性肿瘤组织学分类标准、2002年ATCC的TNM分期和临床分期、1982年Fuhrman病理分级.采用Kaplan-Meier法和Logrank检验对57例获随访的晚期患者行生存分析和预后因素判断. 结果 435例患者中,遗传性VHL病肾癌10例(2.4%)、散发性肾透明细胞癌372例(85.5%)、乳头状癌13例(3.0%)、嫌色细胞癌18例(4.1%)、集合管癌4例(0.9%)、嗜酸性细胞腺瘤4例(0.9 %)、未分类肾癌.14例(3.2%).行根治性肾切除术335例(77.0%),保留肾单位手术74例(17.0%),姑息性肾切除等手术26例(6.0%).遗传性VHL病肾癌均为双肾癌伴多发囊肿,临床分期Ⅰ期7例、Ⅱ期3例,病理分级Ⅰ级6例、Ⅱ级4例,基因测序均存在VHL基因突变,平均随访28.6个月,患者无肿瘤局部进展或转移,但4例患者出现同侧或双侧肿瘤再发.嫌色细胞癌临床分期均为Ⅰ期,病理分级Ⅰ级5例,Ⅱ级13例,平均随访19.8个月均存活,无肿瘤转移或复发.集合管癌临床分期均为Ⅰ期,病理分级均为Ⅲ级,平均生存时间11.3个月.肾透明细胞癌和乳头状癌临床分期Ⅰ期260例(67.6%)、Ⅱ期64例(16.6%)、Ⅲ期32例(8.3%)、Ⅳ期29例(7.5%),其中T1a 147例(38.2%)、T1b 113例(29.4 %);病理分级Ⅰ级124例(32.2%)、Ⅱ级219例(56.9%)、Ⅲ级40例(10.4%)、Ⅳ级2例(0.5%).57例晚期肾癌患者中位生存时间(16.0±1.3)个月,1年生存率55.0%,2年生存率31.0%.预后因素分析显示,临床分期、肿瘤大小、淋巴结转移、远处转移和病理分级是晚期肾癌解剖水平和组织学水平的预后影响因素. 结论 不同组织学亚型的肾癌生物学特征存在较大差异,遗传性VHL病肾癌存在基因突变,常为双侧、多中心、低Fuhrman分级透明细胞癌,易再发不易转移.肾嫌色细胞癌预后较好,而集合管癌预后差.在解剖水平和组织学水平,TNM分期、肿瘤大小、淋巴结转移、远处转移和肾癌病理分级是晚期肾癌的预后影响因素.

Data analysis of renal cell carclnoma database of Shanghai Renji Hospital

Objective To study the histological classification,clinical stage,histological grade and prognosis of renal cell carcinoma by analyzing the records of the patients in Shanghai Renji hospital. Methods A consecutive series of 435 patients with renal cell carcinoma between 2003 and 2005derived from the renal cancer database were reviewed clinically and pathologically.The 1997 version of WHO histological classification for renal epithelial tumor,the 2002 version of AJCC clinical TNM staging system and the 1982 version of Fuhrmaffs system for nuclear grade were used.By survival analysis of 57 cases with advanced renal cell carcinoma using Kaplan-Meier method prognostic factors were confirmed using logrank test. Results Of a total 435 patients,cases were classified into 10(accounting for 2.4%of renal cell tumors)hereditary renal cancer in VHL disease,372(85.5%)clear cell renal cell carcinoma(CCRCC),13(3.0%)papillary renal cell carcinoma(PRCC),18(4.1%)chromophobe renal cell carcinoma(CRCC),4(0.9%)oncocytoma,4(0.9%)carcinoma of the collecting ducts of Bellini(CCDB),and 14(3.2%)renal cell carcinoma unclassified.There were 335(77%)patients undergone radical nephrectomy,74(17%)nephron sparing surgery and 26(6%)others,such as palliative nephrectomy.The patients with VHL disease come from 5 Chinese kindred and all had bilateral clear cell renal cell carcinomas and multifocal renal cysts.There were 7 paients of stage Ⅰ and 3 cases of stage Ⅱ and 6 cases of grade Ⅰ and 4 cases of grade Ⅱ.Genetic test revealed that all patients had VHL gene mutation.4 patients had recurrence while no evidence of local advance and distant metastasis were found during a mean of 28.6 months.Patients with chromophobe RCC are all of stage Ⅰ and 5 cases of grade Ⅰ and 13 cases of gradeⅡ.All patients are alive without recurrence or metastasis during a mean of 19.8 months.Collecting ducts RCC all presented with stage Ⅰ but grade Ⅲand with the median survival only 11.3 Months.Of clear cell and papillary RCC,260(67.6%),64(16.6%),32(8.3 %),29(7.5%)were stage Ⅰ,Ⅱ,Ⅲand Ⅳ,and of stage Ⅰ patients 147(38.2%),113(29.4%)were T1a and T1b respectively.124(32.2%),219(56.9%),40(10.4)and 2(0.5%)were grade Ⅰ,Ⅱ,Ⅲ,Ⅳ,respectively.Median survival of 57 advanced RCC is 16.0±1.3months,1-year survival is 55%,and 2-year survival is 31%,respectively.By using logrank test,clinical stage(＜0.01),tumor size(＜0.01),lymphadenopathy(＜0.01),metastasis(＜0.01)and tumor grade(＜0.01)were anatomical and histological prognostic factors for advanced RCC. Coneluslons Different RCC subtypes have different clinical course.The RCC patients in VHL disease have VHL gene mutation and the tumors are often multifocal,bilateral,clear cell type with a low stage and grade which often recurrence but without metastasis.Chromophobe RCC may have a favorable prognosis but collecting duct RCC poor prognosis.In anatomical and histological level,clinical stage,tumor size,lymphadenopathy,metastasis and tumor grade are prognostic factors of survival for advanced RCC.