肾包膜侵犯状况对于肾癌临床症状及分期的意义

背景与目的：肾细胞癌是致死率最高的泌尿系统肿瘤，肾包膜侵犯状况可能与肾癌的临床病理特征及预后相关，但目前在这方面的研究很少。本研究探讨了肾包膜侵犯状况对于。肾癌临床症状及分期的意义。方法：根据肿瘤与。肾包膜之间的关系把肾包膜侵犯状况分为浸润而未穿透包膜和浸润且穿透包膜。回顾分析2006年在我科接受手术治疗的经病理确诊的101例连续肾癌病例的临床症状、术后病理显示的肾包膜侵犯状况以及TNM分期（AJCC 2002年版），并比较3者之间的联系。结果：55例为体检发现，24例诉腰痛，18例有肉眼或镜下血尿，14例有恶液质等全身症状或者伴有转移症状。大体标本77例肿瘤直径≤7cm，50例44cm。病理T1期68例，T2期9例，〉T2期24例，其中N1-2或M1期的有19例。24例主诉腰痛的病例，肿瘤均未穿透肾包膜；而11例穿透肾包膜的，患者均无腰痛主诉。对于≤4cm的肾癌，腰痛与肾包膜穿透与否无明显相关：当肿瘤〉4cm时，29％（10／35）例无腰痛主诉的病例肿瘤已穿透肾包膜；当肿瘤〉7cm时，53％（8／15）例无腰痛主诉的病例中肿瘤穿透肾包膜；有转移症状或全身症状的病例，43％（6／14）肿瘤穿透肾包膜；无转移症状或全身症状的病例中，6％（5／87）肿瘤穿透肾包膜。40％（40／101）的病例出现肾包膜浸润，其中11例穿透肾包膜：在肿瘤〉7cm的病例中，71％（17／24）出现肾包膜浸润。当肾癌局部未穿透。肾包膜时，是否有包膜浸润对于肿瘤的淋巴结或内脏器官的转移无影响（4／29 vs 9／61，P〉0．05）；当肾癌浸润肾包膜时，如无进一步的肾包膜穿透，则肿瘤转移显著减少（6／11 vs 4／29，P〈0．01）。结论：就诊时腰痛主诉提示肾癌可能尚为局限性病变，对于较大的肾脏占位，如无腰痛主诉，则肿瘤可能已穿透。肾包膜肾包膜侵犯状况与肾癌的临床症状和病理分期有关联。肾包膜浸润在肾癌中比较常见，尤其对于较大的肿瘤，但穿透肾包膜的肿瘤很少。仅仅肾包膜浸润而不穿透不增加肾癌诊断时出现转移的概率，肾包膜的存在一定程度上减少了肿瘤的转移，在限制肿瘤扩散中有一定的保护性作用。

Role of renal capsular involvement status in renal cell carcinoma

Background and pnrpose: Renal cell carcinoma (RCC) was the most lethal urological tumor. Not much data mentioned the correlation between the clinical significance of renal capsular involvement status and the clinical symptoms or stage. Our study was aimed to reveal the clinical significance of renal capsular involvement status in RCC. Methods: We retrospectively analyzed 101 consecutive Chinese RCC patients treated in 2006. All the patients received nephrectomy in our hospital. We documented and compared their clinical symptoms, histopathological findings and clinical stages according to 2002 TNM staging systems. Results: Fifty-five patients had no symptoms at diagnosis, 24 complained of lumbago, 18 endured gross or microscopic hematouria, and 14 had generalized symptoms such as cachexia and/or metastatic symptoms. After pathologic analysis, there were 68 cases confirmed as stage T_1, 9 as stage T_2, and the other 24 cases over stage T_2, of which 19 were stage N_(1-2) or M_1. None of those who complained of lumbago had capsular penetration;all 11 patients with capsular penetration did not complain of lumbago. For those with lesion >4 cm, 29% (10/35) with no complaint of lumbago had capsular penetration. Bad general performance status indicated capsular penetration (Pearson Chi-Square, P<0.001). Capsular invasion was found 40% (40/101) in all, and 71% (17/24) in tumor >7 cm;capsular penetration was 11% in all, and 28% (11/40) in cases of capsular invasion. For cancer confined within kidney, lymph nodes or visceral metastases occurred occasionally regardless of capsular invasion (4/29 vs 9/61, Pearson Chi-Square,P>0.05);for cancer with capsular invasion, the incidence of lymph nodes or visceral metastases decreased without further penetration (6/11 vs 4/29, Pearson Chi-Square, P<0.01). Conclusion: Complaint of lumbago indicates organ confined disease in RCC. For large lesions in kidney, absence of lumbago predict renal capsular penetration. Renal capsular involvement status correlates well with clinical symptoms and TNM stages. Capsular invasion is often seen, especially for large lesions, but further penetration is rare. Capsular invasion without penetration does not increase the risk of systematic metastases, and renal capsular has a protective role against the spread of cancer.