泌尿系统恶性肿瘤副肿瘤综合征的临床特点及意义

Clinical features of urological malignancies with paraneoplastic syndromes

目的 探讨泌尿系统恶性肿瘤（肾细胞癌、前列腺癌、膀胱癌）中副肿瘤综合征（PNS）的临床特点和发病率,分析其与预后的相关性.方法 对2008年1月-2009年12月经手术和病理确诊为肾细胞癌的464例住院病例、2005-2010年确诊为前列腺癌的562例和膀胱癌的647例患者进行回顾性住院资料与随访分析.结果 464例肾细胞癌中发生PNS 156例（33.6%）,主要表现为贫血（26.3%,41/156）、高血压（24.4%,38/156）、发热（21.8%,34/156）、红细胞增多症（19.2%,30/156）、Stauffer综合征（17.3%,27/156）、食欲不振、乏力、体重减轻（15.4%,24/156）、红细胞沉降率加快（12.8%,20/156）、白细胞增多症（8.3%,13/156）、高钙血症（5.1%,8/156）、糖代谢紊乱（1.9%,3/156）、性激素异常（0.6%,1/156）等.肾细胞癌中发生PNS 156例,肿瘤平均直径5.5 em,其余平均直径4.7（P＜0.01）.2例（0.36%,2/562）前列腺癌患者血钾及血糖水平发生异常,均合并多处骨转移,应用全雄激素阻断3个月后血钾及血糖水平恢复正常.在647例膀胱癌患者中尚未发现文献所述PNS表现.结论 泌尿系统恶性肿瘤PNS的发病率由高到低依次为肾细胞癌、前列腺？儋 癌、膀胱癌.PNS的临床表现复杂多样,个别与肿瘤导致异位激素分泌有关,早期诊断后手术切除原发病灶后PNS可消失或有效改善.伴发PNS的患者较不伴发者预后不良.

Objective To investigate the clinical features of paraneoplastic syndromes （PNS） in patients with renal, prostate and bladder cancer and conduct a brief prognostic analysis. Methods From 2008 to 2010, 464 patients of renal cell carcinoma （RCC） confirmed by operation and pathology were reviewed retrospectively. And 562 cases of patients with prostate cancer and 647 with bladder cancer from 2005 to 2010 were also analyzed respectively. Results Among all cases, 156 （33.6%）patients were diagnosed with PNS manifesting with anemia, hypertension, fever, polycythemia, Stauffer＇s syndrome, fatigue, weight loss, anorexia, leukocytosis and hypercalcemia, etc. Two prostate cancer patients had the elevated levels of calcemia and blood glucose respectively. However, no specific clinical presentation in bladder cancer was found to be associated with PNS in this study. Conclusions RCC is the most frequent urological malignancy with PNS. But prostate cancer with PNS is very uncommon and bladder cancer is extremely rare. Most paraneoplastic signs predicate a poor prognosis for the patients.