肿瘤坏死灶与肾嫌色细胞癌预后的关系评估

Tumor necrosis foci and the prognosis of chromophobe renal cell carcinoma

目的提高对肾嫌色细胞癌(CRCC)的诊治水平,并评估肿瘤坏死灶对CRCC预后的影响。方法回顾性分析2001年3月-2007年8月南方医科大学南方医院进行的257例肾癌手术,分析其中18例CRCC的临床及病理资料(采用吻合度测量系数Kappa),比较术前CT扫描及术后病理检查对肿瘤坏死灶的诊断一致性,观察肿瘤坏死灶与CRCC临床病理指标的关系,并结合文献复习讨论。结果本组病例中CRCC的发病率为7.0%(18/257),患者平均58.3±15.6(17～78)岁,肿瘤直径为5.6±4.8cm;TNM病理分期:T1aN0M0期6例,T1bN0M0期4例,T2N0M0期3例,T3aN0M03例,T3cN1M02例;Fuhrman病理分级:G1-G213例,G3-G45例。共15例获得随访,随访期6～60个月,平均31.1±6.2个月,其中1例于术后7个月出现骨转移,2例于术后10、12个月时出现肝转移,其他随访病例未见转移;术前CT与术后病理对肿瘤坏死灶的诊断基本一致(Kappa=0.76),存在肿瘤坏死灶的CRCC直径多>7cm(P<0.05),且以高分级、高分期肿瘤多见(P<0.05)。结论CRCC大多分期、分级较低,预后相对较好。肿瘤坏死与肿瘤直径、分级、分期相关,术前发现CT坏死灶对预测肿瘤的侵袭性具有重要意义。

Objective To improve the diagnosis and treatment of chromophobe renal cell carcinoma （CRCC）, and assess the correla tion between tumor necrosis foci shown on computerized tomography （CT） and the prognosis of CRCC. Methods The clinical data of 257 patients, who had undergone surgical operations for renal cancer in the Urology Institute from Mar. 2001 to Aug. 2007, were retrospectively analyzed, and 18 out of the 257 patients were diagnosed as CRCC. The kappa coefficient drawn from the test of goodness of fit was used to assess the consistency between CT scanning results before operation and the pathological findings after operation. The correlations between the tumor necrosis foci and the clinical pathological parameters of CRCC were assessed and discussed in combination with literature review. Resulls The mean age of 18 patients with CRCC was 58. 3±15. 6 years （ranged from 17 to 78）, the mean tumor size was 5. 6±4.8cm; the pathological staging of TNM was as follous： 6 cases in T1bN9M0）, 4 cases in T1bN0M1, 3 cases in T2N0M0,3 cases in T3aN9M0 and 2 cases in T3cN1M0 ; the Fuhrman nuclear grading was as： 13 tumors in G1-G2 grade and 5 tumors in G3-G1 grade. After a mean follow-up period of 31.1±6. 2 （ranged 6-60） months, 12 patients were alive without tumor metastasis, 3 patients were lost for follow up, and the remaining 3 patients （16. 7%） were found to have metastases, in whom solitary liver metastases was found in 2 patients 11 and 12 months after nephrectomy, and osseous metastases in 1 patient 7 months after nephrectomy. Tumor size, Fuhrman nuclear grading and TNM staging were closely related to necrosis （P〈0. 05）. The preoperative diagnosis by CT-scanning agreed well with the histological coagulative necrosis （kappa=0. 76）. Conclusions A relatively good prognosis may be expected in most of the patients suffering from CRCC. Tumor necrosis is closely related to the tumor size, Fuhrman nuclear grading and TNM staging, and the finding of tumor necrosis is an important prognostic indicator.