青年型肾癌56例报告

Renal cell carcinoma in young adults（report of 56 cases）

目的探讨青年型肾癌的临床特征及诊治措施。方法青年型肾癌56例。男36例，女20例。平均发病年龄32．4岁。偶发癌20例，症状癌36例。病程2d～4年。临床症状有肉眼血尿18例、腰腹胀痛23例、消瘦乏力2例、发热3例、可触及肿块2例，其中有2项以上症状者12例。单侧55例，双侧1例。56例患者均行B超、CT检查，11例患者行KUB加1VU检查，2例行MR检查。50例行根治性肾切除，6例行保留肾单位手术。术后随访7～108个月，平均64个月。结果13超诊断错构瘤4例，多囊肾1例，肾脏炎性肿块1例，肾肿瘤50例；B超检出率89．3％。CT诊断为错构瘤2例，肾肿瘤54例；CT检出率96．4％。行MR检查2例，诊断肾肿瘤1例，错构瘤1例。9例有症状者行KUB加IVU检查，5例示肾集合系统受压，1例未显影，1例示肾盏破坏，2例示肾外形增大；2例偶发癌者行KUB加IVU检查均未见明显异常。20例偶发癌者肿瘤直径1．8～10．0cm，平均4．8cm；其中TIN0M0者16例，T2N0M0者3例，T3N0M0者1例。36例有症状者肿瘤直径2．5～13．0cm，平均8．7cm；其中T1N0M0者20例，T2N0M0者7例，T3N0M0者4例，淋巴结阳性者5例。偶发癌组20例中仅1例（T3N0M0）行根治术者于术后19个月肾窝复发，再次手术治疗，于术后53个月死于全身转移；偶发癌组的5年存活率为92．3％。症状癌组中8例因癌死亡，4例失访，5年存活率为66．7％。2组5年存活率比较差异有统计学意义（P=0．042）。结论青年型肾癌恶性程度与普通人群肾癌相仿，根治性肾切除是主要的治疗方式，合适的患者可行保留肾单位手术。

Objective To investigate the clinical features of renal cell carcinoma in young adults. Methods A retrospective review of 56 patients with age less than 40 years old and diagnosed with RCC from 1997 to 2002 was performed. The average age at diagnosis was 32. 4 years. Tumors were discovered incidentally in 20 patients and symptomatically in 36 patients. The clinical presentations were as follows： 18 cases with gross hematuria, 23 cases with pain, 2 cases with weight loss, 3 cases with fever, 2 cases with flank mass. Twelve cases had more than one presentation. Most cases of this cohort had unilateral tumors except one case with bilateral lesions. Ultrasonography and CT scan were performed in all the patients, intravenous pyelography in 11 cases and magnetic resonance imaging in 2 cases. Fifty cases underwent radical nephrectomy and 6 cases underwent nephronsparing surgery （NSS）. Patients were followed up for an average of 64 months. Results Fifty cases （89.3%） were detected by sonography and 54 cases （96.4%） by CT scan. MRI was performed in 2 cases and one case was misdiagnosed with angioleiomyolipoma similar to CT scan. Intravenous pyelography was performed in 9 symptomatic cases and 2 incidental cases. No abnormalities of IVP were found in 2 incidental cases. But in 9 symptomatic cases abnormalities were found. The diameter of tumor ranged from 1.8 to 10.0 cm in 20 incidental cases with a mean diameter of 4.8 cm. In 36 symptomatic cases it ranged from 2.5 to 13.0 cm with a mean diameter of 8.7 em. Sixteen cases were in T1N0M0 stage in incidental group, 3 cases in T2N0M0 and 1 case in T3N0M0 stage respectively. In symptomatic group, 20 cases were in T1N0M0, 7 in T2N0M0, 4 in T3N0M0 stage, 5 cases with lymph node metastasis. The 5 year cancer specific survival rate was 92.3% for incidentally and 66.7% for symptomatic（P=0. 042）. Conclusions RCC in young adults younger than 40 years old does not exhibit more aggressive than those in older adults in this cohort. Radical nephrectomy would be the main treatment modality and NSS could be an alternative in selected patients.