乳头状肾细胞癌的临床治疗分析——附23例报告

Clinical analysis of the outcome of papillary renal cell carcinoma

目的总结分析乳头状肾细胞癌的临床特点,提高其治疗水平。方法回顾性分析1980～2000年收治的23例乳头状肾细胞癌患者的临床资料。男14例,女9例。中位年龄48岁(24～71岁)。左侧11例,右侧12例。在19例初治的患者中,临床表现血尿8例(42.1%),腰痛7例(36.8%),无症状者4例(21.1%);肾脏肿瘤中位最大径5.5cm(2.5～10.0cm)。另4例为外院术后出现复发和转移。结果乳头状肾细胞癌占同期收治肾癌的2.4%(23/975)。失随访4例。术后总5年生存率69.6%。其中初治19例,5年生存率为84.2%。14例早期局限性癌(T_(1a)～T_2N_0M_0)患者5年生存率100%,但2例分别于术后7年6个月和10年出现转移,其中1例双肺转移患者行肺转移瘤切除和生物化疗后已生存9年且健在,1例失访。3例局部淋巴结转移和2例远处转移的患者中,1例术后2年6个月出现肺转移瘤和切口转移手术联合生物化疗后生存3年,1例同期肺转移瘤患者行肺转移瘤切除和放疗后生存6年,而余3例中,2例失访,1例生存6个月。而外院初治出现复发的4例中,2例患者再次行复发肿瘤切除,分别生存1年和2年6个月,另2例转移患者中,1例生存9个月,1例失访。结论乳头状肾细胞癌在国内少见。早期局限性乳头状肾细胞癌术后预后良好。对于复发或转移的乳头状肾细胞癌患者,手术切除转移瘤或复发瘤可提高生存期。

Objective To investigate the outcome of papillary renal cell carcinoma （PRCC）. Methods ment-naive patients at diagnosis included hematuria （ n = 8 ）, frank pain （ n = 7 ）, and no overt symptom （n = 4）. The median largest diameter of the tumors is 5.5 cm （2. 5 - 10. 0cm）. Results The overall 5-year survival rate was 69.6% for all patients and 84.2% for 19 treatment-naive pa- tients. The overall 5 year survival rate was 100% in 14 patients with localized early disease （T1a - T2N0M0）. Among them, However, two patients developed recurrent disease 90 and 120 months after surgery. Among three patients with involved local lymph node and 2 patients with distant metastases, one survived for 3 years after excision of lung and incision of metastatic lesions, one with synchronous lung metastases survived for 6 years after synchronous excision of the primary and lung metastatic lesions, while 2 were lost during follow - up, and one survived only for 6 months. Among 4 patients at their first relapse who received their initial treatment at other hospitals, 2 patients survived for 12 and 30 months respectively after excision of the metastatic lesions, 1 survived for 9 months, and 1 was lost during follow - up. Conclusion The outcome of PRCC at early stage is favorable. Excision of metastatic lesion may be helpful to prolong the survival of patients with recurrent or metastatic PRCC.