肾肉瘤样癌11例报告并文献复习

Sarcomatoid renal cell carcinoma:11 cases report with literature review

目的：分析肾肉瘤样癌的特点、诊疗及预后，以期提高其诊治水平。方法：回顾性分析2001-01-01—201305～31沧州市中心医院收治的11倒肾肉瘤样癌患者临床资料。男8例，女3例。年龄44～67岁。结果：临床表现肉眼血尿3例,腰痛7例,腹部包块1例；其中2例出现血尿伴患侧腰部疼痛。肿瘤位于左肾3例,右肾8倒。肿瘤平均直径9．9cm。术前TNM分期，T2aN0M01例，T2bN05例，T3aN0M02例，T3aN1M03例。均行根治性肾切除术，术前均行肾动脉栓塞治疗。病理诊断均为肉瘤样癌，光镜下均见恶性纤维组织细胞瘤样结构，细胞呈梭形或不规则形。术后随访2～24个月，10例死亡，1例早期局限性肾肉瘤样癌术后20个月出现双肺多发转移，给予IL-2治疗，术后22个月出现肝转移和骨转移．口服舒尼替尼靶向治疗，病情稳定。结论：手术＋化疗或免疫治疗是目前肾肉瘤样癌首选的治疗方式。早期局限性肾肉瘤样癌术后预后较好，靶向治疗可能成为转移性肾肉瘤样癌治疗的新方向。

OBJECTIVE： To study the characteristics of the sarcomatoid renal cell carcinoma（sRCC） and their prog nosis after nephreetomy. METHODS： Clinical data of 11 sRCC patients（8 males,3 females） with age ranging 44-67 years in Cangzhou Central Hospital from 1st January 2001 to 31st May 2013 were retrospectively reviewed. RESULTS： There were 3 tumors in the left kidney and 8 tumors in the right kidney. The average maximum tumor diameter was 9.9 era. Pa tients presented with gross hematuria（n 3）,flank pain（n=7）,palpable abdominal mass（n=l）. The TNM stages were 1 case of T2aN0M05 cases of T2bN0M0 , 2 cases of T3a N0 M0 and 3 T3aN1M0. All patients were treated with radical ne-phrectomy and renal arterial embolization preoperatively. All pathological diagnosis were sarcomatoid carcinoma. With EM,the spindle cells were visualized. Follow-up was carried out from 2 to 24 months. During the follow up 10 patients were dead. One patient with early stage sRCC developed muhiple lung metastases 20 months after surgery and deteriorated into hepatic,and bone metastases at 22 month after surgery. We offered the patient with targeted therapy and the patient was still alive. CONCLUSIONS： sRCC is riot a common subtype of renal cell carcinoma in China. Early stage sRCC patient can achieve good prognosis after treated with nephrectomy＋chemmherapy（or immunotherapy）. Targeted therapy is a good lreatment option for metastatic papillary renal cell carcinoma patients.