论文部分内容阅读
目的收集、随访并分析16例肾癌伴肉瘤样分化患者临床资料并行文献复习,探讨肾癌伴肉瘤样分化患者临床治疗方法及预后。方法 2005年至2009年我院泌尿外科行肾癌手术的患者共547例,其中伴肉瘤样分化的肾癌16例(2.9%)。男性7例,女性9例;年龄52±10(36～70)岁;临床表现为肉眼血尿者5例,腰酸痛5例,乏力、消瘦2例,咳嗽、咯血1例,体检发现肾脏占位者3例;肿瘤均为单发,其中左侧7例、右侧9例;肿瘤最大径7.8±4.1(2～15)cm。术前充分检查以明确肿瘤分期。术前检查提示腹膜后淋巴结肿大2例,右肺门淋巴结肿大1例,肝转移1例,肾静脉和(或)下腔静脉癌栓2例,骨转移3例,侵犯同侧肾上腺1例,侵犯输尿管上段1例。16例患者均行手术治疗,病理标本常规行H-E染色及免疫组化检查。术后5例患者行INF-α治疗并进行随访。结果所有患者行肾癌根治术,病理结果显示肾透明细胞癌伴肉瘤样分化9例,肾嫌色细胞癌伴肉瘤样分化3例,未分类肾细胞癌伴肉瘤样分化4例。术后分期与术前分期相同。4例pT1N0M0患者随访至今无复发或转移,pT2～T4患者已全部死亡,其无进展生存期为5.6±4.5(2～16)个月,总生存期为8.3±5.6(3～20)个月。结论肾癌伴肉瘤样分化患者术前分期对患者预后影响较大,早期患者行手术治疗是最有效的治疗方法,建议早期患者术后定期复查以监视肿瘤复发、转移等情况,对于晚期患者靶向治疗可能有效。
Objective To collect, follow up and analyze 16 cases of renal cell carcinoma with sarcomatoid differentiation clinical data review and literature review of patients with renal cell carcinoma and sarcomatoid differentiation clinical treatment and prognosis. Methods A total of 547 patients with renal cell carcinoma underwent surgery in our hospital from 2005 to 2009, of which 16 (2.9%) had sarcomatoid renal cell carcinoma. 5 cases of gross hematuria, 5 cases of lumbago, fatigue, weight loss in 2 cases, cough, hemoptysis in 1 case, physical examination found kidney space In 3 cases. The tumors were all single. There were 7 cases on the left and 9 cases on the right. The maximum diameter of tumor was 7.8 ± 4.1 (2-15) cm. Preoperative examination to clear the tumor staging. Preoperative examination revealed 2 cases of retroperitoneal lymph node enlargement, 1 case of right hilar lymph node enlargement, 1 case of liver metastasis, 2 cases of renal vein and / or inferior vena cava tumor thrombus, 3 cases of bone metastasis, infiltration of ipsilateral adrenal 1 Cases, violation of the upper ureter in 1 case. All the 16 patients underwent surgical treatment. H-E staining and immunohistochemistry were routinely performed in pathological specimens. Postoperative five patients underwent INF-α treatment and follow-up. Results All patients underwent radical nephrectomy. The pathological findings showed 9 cases of renal clear cell carcinoma with sarcomatoid differentiation, 3 cases of renal chromophobe and sarcomatoid differentiation, and 4 cases of unclassified renal cell carcinoma with sarcomatoid differentiation. Postoperative staging and preoperative staging the same. All 4 patients with pT1N0M0 had no recurrence or metastasis since follow-up. The patients with pT2-T4 had all died, the progression-free survival was 5.6 ± 4.5 (ranged from 2 to 16) months and the overall survival was 8.3 ± 5.6 (ranged from 3 to 20) months . Conclusion The preoperative staging of patients with renal cell carcinoma and sarcomatoid differentiation has a great influence on the prognosis of patients. Surgical treatment of early patients is the most effective treatment. Early patients should be reviewed regularly to monitor the recurrence and metastasis of tumor. To the treatment may be effective.