偶发性肾癌的临床分析

Incidental renal cell carcinoma: analysis of 109 cases

目的 探讨偶发性肾癌的临床特征、诊治方法和影响预后的因素。 方法 回顾性分析近 2 0年来收治的 10 9例偶发性肾癌患者的临床资料 ,并与 2 4 7例同期治疗的非偶发性肾癌进行对比。 结果 偶发性肾癌组和非偶发肾癌组在发病年龄、性别、单双侧和病理类型等方面差异无显著意义 ;偶发性肾癌平均直径 (4 1± 1 7)cm ,非偶发肾癌平均直径 (6 4± 3 2 )cm ,差异有显著意义 (t=6 72 ,P <0 0 1) ;偶发性肾癌的病理分期明显低于非偶发肾癌 (χ2 =2 10 .5 2 ,P <0 0 1) ;术后 3年(84 1% )和 5年 (6 8 5 % )生存率高于非偶发肾癌 (χ2 =7.5 1,P <0 0 1)。 1990～ 1999年检出偶发性肾癌 92例 (84 4 % )明显高于 1980～ 1989年的 17例 (15 6 % ,χ2 =19.4 7,P <0 0 1)。B超和CT能明显提高偶发肾癌的检出率 (χ2 =16 6 4 ,P <0 0 1) ;偶发肾癌手术疗效明显优于非偶发肾癌 (χ2 =14 5 4 ,P <0 0 1)。 结论 偶发性肾癌是肾癌未出现临床表现的一发展阶段 ,并非肾癌的另一类型。B超和CT是发现偶发性肾癌的主要诊断方法。此类型的病理分期低、瘤体小。

Objective To study the characteristics, diagnosis,treament and prognosis of incidental renal cell carcinoma(RCC). Methods 109 cases of incidental RCC treated in 20 years were analyzed retrospectively and compared with 247 cases of non incidental RCC. Results The age,sex and side between incidental RCC and non incidental RCC were not significant( P >0 05).Compared to the non incidental RCC,the diameter of incidental RCC [(4 1±1 7) cm] was smaller and its stage was lower ( P <0 01). Ultrasonogrphy and CT can improve the detection rate of incidental RCC significantly, and operation is more effective for incidental RCC than for non incidental RCC ( P <0 01). The 3 and 5 year cancer specific survival rates in patients with incidental RCC were higher than those of non incidental RCC( P <0 01). The detection rate of incidental RCC was higher from 1990 to 1999(39 3%) than from 1980 to 1989(15 6%)( P <0 01). Conclusions Incidental RCC is not another type of RCC,but a developing stage of RCC without appearance of asymptoms. Ultrasonogrphy and CT are important to diagnose incidental RCC. Low pathological stage, small size,early diagnosis, and radical nephrectomy indicate better prognosis of incidental RCC.