青年肾癌21例临床观察

目的探讨青年肾癌临床特征及诊断、治疗措施。方法回顾性分析1998年2月至2004年8月期间21例40岁肾癌患者资料。结果术后病理诊断透明细胞癌14例,混合性细胞癌3例,低分化及未分化细胞癌4例。术后TNM分期:T_1N_0M_0 10例,T_2N_0M_0 6例,T_0N_0M_0 3例,T_3N_1M_0 2例。19例术后随访2～93个月(2例失访),4例死亡(均于术后2年内),其余15例均无瘤生存。结论青年肾癌偶发癌比例较高,但早期症状缺乏特异性;疑及肾脏肿瘤的患者宜尽早行影像学检查;根治性肾切除术是主要治疗方式,对合适的患者可行保留肾单位手术;预后与病理类型、肿瘤分期密切相关。

Renal Cell Carcinoma In Young Adults On 21 Cases

Objective To investigate the clinical features of renal cell carcinoma（RCC） in young adults for improving its diagnosis and treatment. Methods A total of 21 patients with RCC under the age of 40 years from February 1998 to August 2004 were analyzed retrospectively.The average age at diagnosis was 31.67 years（age range,20-39 years）.Tumors were discovered incidentally in 9 patients.The clinical presentations were as follows：hematuria in 6 cases,back and/or abdominal pain in 9,abdominal mass in 2,fever in 3,debility in 2,nausea in 1,urinary irritation in 1 and 3 patients did not have specific symptoms at RCC diagnosis.Ultrasonography and CT scan were performed in all patients,intravenous pyelography in 4 cases,MRI in 2 cases and DSA in 1 case. The tumor size was 3～20cm in diameter（mean,9.68cm）.Eighteen cases underwent radical nephrectomy and 3 cases underwent nephron-sparing surgery（NSS）. Patients were followed up for an average of 64.79 months（range,2-93 months）.Results Fourteen cases were pathologically diagnosed as clear cell carcinoma, cases as mixed cell carcinoma,4 cases as low-differentiated and undifferentiated cell carcinoma.Ten cases were in T_1N_0M_0 stage,6 cases were in T_2N_0M_0 stage, 3 cases were in T_3N_0M_0 stage and 2 cases were in T_3N_1M_0 stage.Of the 21 cases,19 were followed for 2～93 months（two cases were lost）.Four of them died within 2 years after operation.The remaining 15 cases were alive and free of tumor.Conclusions The percentage of incidental tumor in young adults was relatively high.The early symptom was lacking of tumor specificity.The imaging examinations should be done as earlier as possible in young adults suspected of kidney tumor.Radical nephrectomy would be the main treatment modality and NSS could be an alternative in selected patients.Prognosis is closely related with pathological types and clinical stages.