多房囊性肾细胞癌的诊断和治疗分析

Diagnosis and treatment of multilocular cystic renal cell carcinoma:a study of 22 cases

目的 分析多房囊性肾细胞癌病例的临床资料。方法 1998年 1月至 2 0 0 2年 12月 ,北京大学第一医院泌尿外科共收治 4 82例肾癌患者 ,其中多房囊性肾细胞癌 2 2例 ,总结临床资料进行分析。结果 多房囊性肾癌占同期肾癌病例的 4 5 6 % ,男女比例是 2 6 7∶1,与同期非多房囊性肾癌患者比较 (男∶女为 2 0 9∶1) ,其性别构成差异无显著意义 (P >0 0 5 ) ,但其平均年龄 (46 6岁 )低于后者(5 7 83岁 ) ,P <0 0 1。其中pT1N0 M0 期肿瘤 6例 ,pT2 N0 M0 期肿瘤 15例 ,pT3 bN0 M0 期肿瘤 1例 ;G1级肿瘤 5例 ,G2 级肿瘤 17例。结论 多房囊性肾细胞癌是肾癌的一种特殊类型 ,诊断主要依据影像学检查 ,术前鉴别非常困难。对诊断不清的病例 ,尤其对于Bosniak分类在三级或以上者 ,行术中冰冻病理检查或采用保留肾组织的手术治疗 ,可使患者受益。

Objective To summarize the diagnosis and treatment of multilocular cystic renal cell carcinoma (MCRCC),a special subtype of renal cell carcinoma. Methods The clinical data of 22 cases of MCRCC diagnosed and treated from January 1998 to December 2002 in the First Hospital of Peking University were analyzed retrospectively. Results 482 patients with renal cell carcinomas were hospitalized during that period with a male-to-female ratio of 2.09∶1. Out of the 482 cases 22 cases (4.56%) were classified as MCRCC with a male-to-female ratio of 2.67∶1,not significantly different from that of the general group of renal cell carcinoma patients( P >0.05). The mean age of the patients of MCRCC was 46.6 years,significantly lower than that of the patients with other types of renal cell carcinomas (57.83 years, P < 0.01). Eighteen cases were diagnosed correctly as renal carcinomas before operation. Six patients (27%) were at the stage pT 1N 0M 0,15 (68%) at the stage pT 2N 0M 0,and 1 (5%) at the stage pT 3bN 0M 0. The classification according to the tumor nuclear grading system showed 5 carcinomas (23%) of tumor nuclear grade 1,17(77%) are of tumor nuclear grade 2. Eighteen patients underwent radical renal nephrectomy and 4 underwent partial nephrectomy. Conclusion The preoperative diagnosis of MCRCC,difficult to be differentiated from other cystic renal diseases,mainly depends on imaging studies. Intraoperative frozen-section or nephron sparing surgery will benefit the patients if the preoperative diagnosis is unclear,especially for the patients of category 3 or 4 of Bosniak's system.