年龄和环境对肾细胞癌临床病理特征的影响

Effects of Age and Circumstance on Clinicopathologic Features of Renal Cell Carcinoma

目的探讨不同年龄和生活环境的肾细胞癌的临床病理特征。方法回顾性分析256例肾细胞癌患者的年龄、临床症状、临床分期、淋巴结转移、远处转移、病理特征等方面资料,比较<40岁组、40～60岁组和>60岁组间及农村和城市间的临床及病理特征。结果①在肾细胞癌中透明细胞癌的所占比例随年龄增长而增加,三组间两两比较差异有统计学意义(P=0.01);嫌色细胞癌和集合管癌的所占比例则随年龄增长逐渐减少,三组间两两比较差异有统计学意义(P=0.047);肾细胞癌病理类型与环境无关。②40～60岁组中无症状肾细胞癌所占比例均高于<40岁组与>60岁组,且与<40岁组比较有显著性差异(P=0.02);Ⅲ期肾细胞癌在40～60岁组中的比例明显低于<40岁组(P=0.04)和>60岁组(P=0.059),且前者差异有统计学意义;农村肾细胞癌患者中Ⅰ期肾癌比例低于城市组(P=0.0001),而Ⅲ期肾细胞癌(P=0.0007)和Ⅳ期肾细胞癌(P<0.0001)比例显著高于城市。③40～60岁组肾细胞癌患者淋巴结转移比例低于<40岁组(P=0.028)和>60岁组(P=0.035),差异有统计学意义;农村肾细胞癌患者淋巴结转移(P<0.0001)和远处转移(P=0.002)的比例也显著高于城市。结论不同年龄段肾细胞癌的临床及病理特征存在差异,农村和城市间病理特征没有差异而临床特征有差别;加强肾细胞癌的早期诊断和早期治疗应重视中年人(40～60岁)和农村人群,不可忽视年轻人群(<40岁)、老年人群(>60岁)。

Objective To evaluate the clinicopathologic features of renal cell carcinoma in different ages and circumstance.Methods 256 consecutive cases of renal cell carcinoma（RCC） were reviewed retrospectively.The patients were classified into 3 groups： 40 years group,40-60 years group and 60 years group.The ages,clinical presentations,pathological types,clinical stages and lymph node metastasis were compared.Results The percentage of clear cell RCC increased with the increase of Age.there were significant differences when the component ratios were compared among the 3 groups（P = 0.01） ;The percentage of chromophobe RCC and collecting duct carcinoma diminish with the increasing age,there were significant differences when the component ratios were compared among the 3 groups（P = 0.047） ;there was no difference between city and country.② The percentage of incidental tumor in 40 years group and 60 years group was lower than that in 40-60 years group,there was significant difference between 40 years group and 40-60 years group（P = 0.02） ;The percentage of stage Ⅲ in 40-60 years group was lower than those and in 40 years group（P = 0.04） and 60 years group（P = 0.059）,there were significant differences between 40 years group and 40-60 years group;the percentage of stage Ⅰ in rural areas was significantly lower than the group in city,the percentage of stage Ⅲ and the percentage of stage Ⅳ were significantly higher than the proportion of cities.③In 40-60 years group,the proportion of lymph node metastasis occurred in patients with RCC,which was significantly lower than those in 40 years group（P = 0.028） and 60 years group（P = 0.035） ;in rural areas the proportion of lymph node metastasis（P 0.0001） and the proportion of distant metastasis（P = 0.002） occurred in patients with renal RCC,which were significantly higher than those in city.Conclusion There were different clinicopathologic features in different age groups,however,there was no difference and significantly differences in pathological types between rural areas with city.