以转移灶为首发临床表现的肾癌患者临床特征分析

目的分析以转移灶为首发临床表现肾癌患者的临床特征。方法回顾性分析了32例以转移灶为首发临床表现肾癌患者的临床资料,男性24例,女性8例,中位年龄56岁。结果患者以骨转移灶(下肢痛4例、胸痛3例、背痛3例、枕部结节3例、胸壁肿物2例、肩疼1例、髂区痛1例、下肢麻木1例)、肺转移灶(咳嗽7例、咳血2例、体检发现肺占位2例)、脑转移灶(头痛1例、头晕1例)及淋巴结转移灶(颈部肿物1例)的症状和体征为首发临床表现。多发转移27例、单发转移5例。透明细胞癌31例、乳头状癌1例。肾肿瘤中位直径7.5cm。有肾原发灶病理资料的28例患者中,T1期7例、T2期12例、T3a期9例,G12例、G211例、G312例、G43例,11例伴脉管瘤栓。全身治疗为干扰素-α+白细胞介素-Ⅱ(24例)、索拉非尼(4例)及舒尼替尼(4例)。28例行减瘤肾切除术,11例行转移灶姑息放疗或切除。本组30例获随访,23例死亡,患者的中位生存期10个月(4个月～7年)。2例单发骨转移的患者,经全身治疗联合减瘤肾切除及转移灶切除或放疗,分别无瘤生存7年及19个月。结论以转移灶为首发临床表现的肾癌患者,骨转移造成的临床表现最为常见。患者多为多发转移、伴不良病理预后因素,预后差、生存期短。对孤立骨转移的患者,全身治疗辅以原发灶及转移灶的姑息治疗,部分患者可能长期生存。

Clinical Analysis of Patients with Renal Cell Carcinoma Initially Manifestating Based on Metastatic Disease

Objective To analyze the clinical features of patients with renal cell carcinoma(RCC)initially manifestating based on metastatic disease.Methods We retrospectively reviewed clinical data of 32 RCC patients with initial manifestations caused by metastatic disease.Twenty-four men and 8 women were identified with a median age of 56 years.Results The initial manifestations were caused by bone metastasis(4 cases of leg pain,3 of chest pain,3 of back pain,3 of occipital mass,2 of chest mass,1 of shoulder pain,1 of iliac region pain and 1 of acroanesthesia of legs),lung metastasis(7 of cough,2 of hemoptysis and 2 of detected lung mass in health examinations),brain metastasis(1 of headache and 1 of dizziness) and lymph node metastasis(1 of cervical mass).Twenty-seven cases had multiple and 5 had single metastasis.Thirty-one cases were clear cell carcinoma and 1 was papillary carcinoma.The median diameter of renal tumor was 7.5 cm.Of the 28 patients who had primary renal tumor pathological data,stages were 7 with T1,12 with T2,9 with T3a.Grades were 2 with grade 1,11 with grade 2,12 with grade 3 and 3 with grade 4.Vessel tumor embolus were seen in 11 cases.Systemic treatment were interferon alfa combined with interleukin-Ⅱ(24 cases) or sorafenib(4 cases) or sunitinib(4 cases).Twenty-eight patients had cytoreductive nephrectomy.Eleven had palliative radiation therapy or ablation for the metastatic diseases.Conclusions Manifestations caused by bone metastasis is the most common sings or symptoms in patients with RCC initially manifestating based on metastatic disease.The majority patients had multiple metastasis and usually with poor pathological prognostic factors.The prognosis of these patients was poor and life span was short.Systemic treatment combined with palliative therapy for primary and metastatic disease seems to be effective in achieving relatively long-term survival in some patients with single bone metastasis.