不同肾细胞癌亚型临床病理学特征比较

The comparison of clinicopathological features in different subtypes of renal cell carcinoma

目的 探讨不同肾细胞癌（RCC）亚型临床病理学特征差异.方法 对比不同RCC亚型基本临床特征、大体表现、Fuhman细胞核分级、侵犯情况、TNM分期以及预后.结果 在所有RCC中,透明细胞癌占88.5％ （718/809）,乳头状癌占4.1％（33/809）,嫌色细胞癌占1.7％ （14/809）,囊性肾细胞癌占3.1％（25/809）,未分类癌占2.2％ （18/809）,其他类型占0.4％（3/809）;上述类型Fuhman细胞核分级中3级分别占16.1％、48.5％、42.9％、8.0％、16.7％以及0.0％;肾盂侵犯分别占44.4％、10.3％、27.0％、0.0％、0.0％以及0.0％;肾周脂肪侵犯分别占11.8％、11.5％、33.3％、0.0％、44.4％以及33.3％;淋巴结转移分别占0.9％、19.2％、0.0％、6.3％、27.8％以及33.3％;远处转移分别占2.3％、7.6％、0.0％、6.3％、16.7％以及0.0％;3年肿瘤特异性生存率分别为92.1％、100.0％、100.0％、100.0％、61.5％以及100.0％.结论 透明细胞癌是最常见的病理学亚型.未分类癌是预后最差的亚型,而囊性肾细胞癌预后最好.乳头状癌和嫌色细胞癌细胞核分级较高,且肾盂和肾周脂肪侵犯较常见.

Objectives To investigate the clinicopathological characteristics in different subtypes of renal cell carcinoma（RCC）.Methods We studied and compared basic clinical features,gross appearance,Fuhman nuclear grade,invasion,TNM staging and prognosis of different subtypes of RCC.Results There were 718 （88.5%） patients with clear cell carcinoma,33 （4.1%） with papillary carcinoma,14 （1.7%） with chromophobe cell carcinoma,25 （3.1%） with cystic renal cell carcinoma,18 （2.2 %） with unclassified cancer,and 3 （0.4%） with other types.Fuhman nuclear grading 3 was present in 16.1%,48.5%,42.9%,8.0%,16.7% and 0.0% cases in above-mentioned different subtypes.The presence of renal pelvis invasion was 10.3%,27.0%,0.0%,44.4% and 0.0% in different subtypes respectively.Renal perirenal fat invasion accounted for 11.8%,11.5 %,33.3 %,0.0% and 33.3% in different subtypes respectively.Lymph nodes metastasis were found in 0.9%,19.2 %,0.0 %,6.3 %,27.8 and 33.3% cases respectively.Distant metastasis accounted for 2.3%,7.6 %,0.0 %,6.3 %,16.7% and 0.0% in different subtype,respectively.The 3-year cancer-specific survival for above-mentioned different subtype was 92.1%,100.0 %,100.0 %,100.0%,61.5% and 100.0%,respectively.Conclusions Clear cell carcinoma is the most common pathological subtype.Unclassified cancer is the worst prognosis subtype,and cystic renal cell carcinoma with best prognosis.Papillary and chromophobe cell carcinoma are higher grade in nuclear grade.The invasion in renal pelvis and renal peripheral fat is more common in papillary and chromophobe renal cell carcinoma.