青年和中老年肾脏恶性肿瘤患者临床病理特点分析

目的 探讨青年和中老年肾脏恶性肿瘤患者临床病理特点. 方法 回顾性分析1986-2007年收治的83例青年(≤40岁)与703例中老年(＞40岁)肾脏恶性肿瘤患者的临床及病理资料. 结果 青年女性患者首发症状中腹痛(12/27,44.4%)和肿块(2/27,7.4%)发生率显著高于中老年组(154/703,21.9%和154/703,1.3%),均P＜0.05.青年组透明细胞癌(47/83,56.6%)发生率低于中老年组(501/703,71.3%),P＜0.05,以青年男性(31/56,55.4%)显著.青年组乳头状肾癌(21/83,25.3%)发生率较中老年组患者(118/703,16.8%)有升高趋势(P=0.054),其中青年男性(17/56,30.4%)显著(P=0.011);与中老年组患者(12/703,1.7%)相比,青年组其他类型肿瘤(包括恶性纤维组织细胞瘤、平滑肌肉瘤等)所占比例(6/83,7.2%)明显增高(P＜0.05),以青年女性(4/27,14.8%)显著;青年男性组肿瘤≤4 cm比例明显高于中老年组(24/56,42.9%与173/703,24.6%);＞7 cm比例(12/56,21.4%)则低于中老年组(295/703,42.0%),均P＜0.05.青年组5年生存率为91.6%(76/83),中老年组为80.9%(669/709),2组比较差异有统计学意义(P＜0.05).结论 与中老年组肾脏恶性肿瘤患者相比,青年组患者总体预后较好.青年女性患者临床表现典型,预后较差;而青年男性乳头状肾癌、小肾癌比例较高,预后较好.提示应加强对青年人群特别是对青年女性的肾肿瘤普查.

Clinicopathologic features of renal malignant tumour in younger and elder patients

Objective To investigate the clinic pathologic features of young patients with renal malignant tumour by comparing with older patients. Methods The clinical data of 83 younger adults(age,≤40 years) with renal cell carcinoma and 703 cases of older renal cell carcinoma (age＞40 years)was analyzed and compared retrospectively. All of the patients were surgically treated between 1986and 2007. Results Among patients with symptoms, younger female patients were more likely to have abdominal pain(12/27, 44.4% vs. 154/703, 21.9%)and mass (2/27, 7.4% vs. 154/703,1.3%)than older (P＜0.05). The older groups were more likely to have dear cell carcinoma than in the younger(501/703, 71.3% vs. 47/83, 56.6%)(P＜0.05). The rate of PRCC has the trends to be higher in young patients than that in older patients (21/83, 25.3% vs. 118/703, 16.8%) (P=0.054),especially in male patients (17/56, 30.4 %) (P=0.011). The rate of MFH and leiomyosarcoma was significantly higher in young patients than that in older patients (6/83, 7.2% vs. 12/703,1.7%) (P＜ 0.05), especially in female patients (4/27,14.8%). Younger male patients were more likely to have a higher incidence of small tumors (T≤4 cm)(24/56,42.9 % vs. 173/703,24.6 % )(P＜0.05)and a lower incidence of big RCC(T＞7 cm) than older patients(12/56,21.4% vs. 295/703,42.0%) (P＜0.05). Conclusion Younger female renal cell carcinoma patients tends to have worseprognosis than older patients, while younger male patients have better prognosis due to different pathology.