青年肾癌的临床及病理学特点

Renal cell carcinoma in young patients:clinicopathoiogic characteristics

目的探讨青年肾癌的临床及病理学特点,提高对青年肾癌的认识。方法回顾性分析1983年8月至2005年6月732例肾癌患者资料,其中＜35岁患者35例,占4．8%。男22例,女13例。年龄19～35岁,平均31岁。临床表现无痛性血尿12例(34%)、腰痛12例(34%)、腹部包块2例(6%)、发热3例、Stauffer综合征1例。肿瘤直径1．2～13．8 cm,平均6．0 cm。AJCC分期：Ⅰ期8例、Ⅱ期4例、Ⅲ期18例、Ⅳ期5例。行根治性肾切除术28例(包括3例同时行腔静脉瘤栓取出术,1例腔静脉取瘤栓加肺叶切除术)、肾部分切除术5例、未手术2例。结果34例手术患者(其中1例仅行探查取活检)术后病理为透明细胞癌23例、混合型细胞癌5例、乳头状细胞癌和嫌色细胞癌各2例、低分化及未分化细胞癌各1例。26例患者随诊12～148个月,平均56个月。术后3、5年生存率分别为65%、50%。结论青年肾癌早期症状隐匿,缺乏特异性,易忽视,确诊时临床分期相对较晚,恶性程度相对较高,易引起组织浸润和远处转移,预后相对不良。

Objective To study the clinical features, pathological characteristics and prognosis of renal cell carcinoma （RCC） in young adults,and to improve the recognition of RCC in young population. Methods The data of 35 young patients with RCC under the age of 35 years from August 1983 to June 2005 were analyzed retrospectively. There were 22 males and 13 females with a mean age of 31 years （age range, 19 -35 years）. The clinical presentations were as follows： painless hematuria in 12 cases （34%） ,low back pain in 12（34% ） , abdominal mass in 2（6% ）, fever in 3 and Stauffer syndrome in 1. The tumor size was 1.2 - 13.8 cm in diameter （ mean, 6.0 cm）. AJCC staging showed stage Ⅰ tumor in 8 cases,stage Ⅱ in 4, stage Ⅲ in 18 and stage Ⅳ in 5. Of the 35 cases,28 underwent radical nephrectomy （including simultaneous extraction of the vena cava cmboli in 3 cases and extraction with pulmonary lobectomy in 1 ） ;5 cases underwent partial nephrectomy;and 2 cases lost the chance of operation （ 1 of them had biopsy）. Results The operations were successful. The postoperative pathologic diagnoses consisted of clear cell carcinoma in 23 cases, mixed cell carcinoma in 5, papillary cell carcinoma in 2 ,and chromophobe cell carcinoma in 2, low-differentiated and undifferentiated cell carcinoma each in 1. Of them, 26 cases were followed for 12 - 148 months （mean,56 months）. Postoperative 3- and 5- year survival rates were 65% and 50% ,respectively. Conclusions In young population, RCC is difficult to diagnose because of occult symptoms at early stage and lack of tumor specificity, which leads to relatively late clinical staging at diagnosis. RCC is characterized by higher malignancy, easy invasion to surrounding tissues and metastasis, and thus poor prognosis.