乳头状肾细胞癌临床分析

目的：总结分析乳头状肾细胞癌的临床特点,提高其诊治水平.方法：回顾性分析2003～2009年收治的乳头状肾细胞癌的临床资料.并与同期53例肾透明细胞癌比较.结果：乳头状肾细胞癌组患者年龄57.3（47～78）岁,皆为男性,占同期肾细胞癌9.4%.就诊时3例无症状,2例出现肉眼血尿,1例双侧腰痛伴腹部包块.肿瘤平均最大径为6.6（2.6～16.0）cm,未见多中心病灶.TNM分期：T1a N0 M0 3例,T1b N0 M0 1例,T2 No M0 2例 病理分型I型3例,Ⅱ型3例 Fuhrman分级Ⅱ级2例,Ⅲ级4例.与肾透明细胞癌相比,乳头状肾细胞癌好发于男性,影像学检查不具备恶性肿瘤特征,确诊有赖于病理和免疫组织化学检查.临床分期皆为I期或Ⅱ期.就诊时无一例出现远处转移.结论：乳头状肾细胞癌在临床表现上与肾透明细胞癌相似,但在影像学表现、病理形态及生物学行为上均与肾透明细胞癌有所不同.根治性肾切除术是目前首选治疗方式.靶向治疗有可能成为转移性乳头状肾细胞癌治疗的新方向.

Clinical Analysis of Papillary Renal Cell Carcinoma

Objective：To investigate the clinical features of papillary renal cell carcinoma （RCC） to improve the diagnosis and treatment. Methods： Retrospective analysis the clinical data of Papillary renal cell carcinoma from 2003 to 2009 ,and compared with 53 cases of renal clear cell carcinoma. Results：The mean age of patients with papillary RCC was 57.3 years （ranged from 47 to 78） and all patients were males ,accounts for 9.4% of the renal cell carcinoma in the same period . 2 patients presented with gross hematuria, 1 with loin pain and 3 without any symptom being detected. The average largest dimension of tumors was 6.6（2.6-16.0） cm. Of these 6 patients, 3 （50%） and 3 （50%） were diagnosed as type 1 and type 2 papillary RCC, respectively. The TNM stage was T1a N0 M0 in 3 patients, T1b N0 M0 in 1 patients and T2 N0 M0 in 2 patients. Fuhrman＇s nuclear grade was grade 2 in two patients and grade 3 in four patients. Males were associated with the high prevalence rate of papillary RCC. The radiological manifestation of papillary RCC was similar to benign tumors and definite diagnosis depended on the typical pathological features and immunohistochemical results. Compared to RCC, papillary RCC tended to present at an early stage. Conclusions： Papillary renal cell carcinoma in clinical performance was similar to renal clear cell carcinoma. But imaging, pathological and biological behavior of renal clear cell carcinoma are different. Radical nephrectomy is the treatment of choice. Radical nephrectomy is the optimal treatment by now and molecular targeted therapy has been the new development trend towards metastatic papillary RCC.