偶发性肾癌的临床分析

目的　探讨偶发性肾癌的临床特征、诊治方法和影响预后的因素。　方法　回顾性分析近 2 0年来收治的 10 9例偶发性肾癌患者的临床资料 ,并与 2 4 7例同期治疗的非偶发性肾癌进行对比。　结果　偶发性肾癌组和非偶发肾癌组在发病年龄、性别、单双侧和病理类型等方面差异无显著意义 ;偶发性肾癌平均直径 (4 1± 1 7)cm ,非偶发肾癌平均直径 (6 4± 3 2 )cm ,差异有显著意义 (t=6 72 ,P <0 0 1) ;偶发性肾癌的病理分期明显低于非偶发肾癌 (χ2 =2 10 .5 2 ,P <0 0 1) ;术后 3年(84 1% )和 5年 (6 8 5 % )生存率高于非偶发肾癌 (χ2 =7.5 1,P <0 0 1)。 1990～ 1999年检出偶发性肾癌 92例 (84 4 % )明显高于 1980～ 1989年的 17例 (15 6 % ,χ2 =19.4 7,P <0 0 1)。B超和CT能明显提高偶发肾癌的检出率 (χ2 =16 6 4 ,P <0 0 1) ;偶发肾癌手术疗效明显优于非偶发肾癌 (χ2 =14 5 4 ,P <0 0 1)。　结论　偶发性肾癌是肾癌未出现临床表现的一发展阶段 ,并非肾癌的另一类型。B超和CT是发现偶发性肾癌的主要诊断方法。此类型的病理分期低、瘤体小、早期发现和尽早根治性肾切除术是偶发性肾癌预后较好的重要因素

Incidental renal cell carcinoma: analysis of 109 cases

OBJECTIVE: To study the characteristics, diagnosis,treatment and prognosis of incidental renal cell carcinoma(RCC). METHODS: 109 cases of incidental RCC treated in 20 years were analyzed retrospectively and compared with 247 cases of non-incidental RCC. RESULTS: The age, sex and side between incidental RCC and non-incidental RCC were not significant (P > 0.05). Compared to the non-incidental RCC,the diameter of incidental RCC [(4.1 +/- 1.7) cm] was smaller and its stage was lower (P < 0.01). Ultrasonography and CT can improve the detection rate of incidental RCC significantly, and operation is more effective for incidental RCC than for non-incidental RCC (P < 0.01). The 3 and 5 year cancer specific survival rates in patients with incidental RCC were higher than those of non-incidental RCC(P < 0.01). The detection rate of incidental RCC was higher from 1990 to 1999 (39.3%) than from 1980 to 1989 (15.6%) (P < 0.01). CONCLUSIONS: Incidental RCC is not another type of RCC, but a developing stage of RCC without appearance of a symptoms. Ultrasonography and CT are important to diagnose incidental RCC. Low pathological stage, small size, early diagnosis, and radical nephrectomy indicate better prognosis of incidental RCC.