单纯侵犯腹膜的T4期肾癌临床分析

Clinical features and prognosis of renal cell carcinoma patients with peritoneal invasion only

目的 了解单纯侵犯腹膜并且无淋巴结及全身转移的T4期肾癌患者的临床特点及手术疗效.方法 回顾性分析1999年1月至2012年2月收治的16例单纯侵犯腹膜并且无淋巴结及全身转移的T4期肾癌患者的临床资料,男9例,女7例.年龄33～ 78岁,中位年龄65岁.肿瘤位于左肾6例,右肾10例.肾肿瘤最大径5.5～ 17.0 cm,中位数为8.5 cm.16例均侵犯腹膜.16例均成功行根治性肾切除术及受累腹膜切除术.术后病理诊断透明细胞癌14例,乳头状肾细胞癌2例.结果 单纯侵犯腹膜的T4期肾癌占同期收治肾癌的0.21％（16/2 889）,占同期T4期肾癌的21.62％（16/74）.16例均获随访,随访时间18～134个月,其中8例术后出现远处转移,中位转移时间6.5个月;术后无瘤生存9例（其中1例甲状腺转移行手术切除后无瘤生存）,带瘤生存1例,死亡6例.3年、5年累积生存率分别为79.32％和64.90％.结论 单纯侵犯腹膜的T4期肾癌临床上少见,通过手术完整切除患肾及受侵犯的腹膜者预后良好.

Objective To study the clinical features and prognosis of renal cell carcinoma patients with peritoneal invasion but without lymphatic or systemic metastasis （T4NoM0）. Methods We reviewed patients with pathological stage of T4NoM0 from Jan. 1999 to Feb. 2012. There were 16 patients （9 males, 7 females） met the inclusion criteria. There were 6 tumors on the left while other 10 on right. The median pa- tient age was 65 （ranged from 33-78） years, the medium size of the mass was 8.5 （ranged from 5.5-17.0） cm. Peritoneum was invaded in all these patients and all of them had radical nephrectomy and resection of a contiguous peritoneum successfully. Results These patients accounted for 0.21% （16/2889） of all renal cell carcinoma cases or 21.62% （16/74） of all T4NxM cases during this period. All patients were followed- up for 18-134 month. Metastases were found in 8 patients at a median 6.5 （ranged from 1-41） month after surgery. 9 patients were survival with disease-free, 1 patient were survival with disease progression, 6 pa- tients died after surgery. The 3 years and 5 years of cumulative survival rate were 79.32% and 64.90%, re- spectively. Conclusions The incidence of renal cell carcinomas with peritoneal invaded only is rare. Pa- tients accept a successfully radical nephrectomy and resection of a contiguous peritoneum will have a good prognosis.