肾癌伴下腔静脉瘤栓患者临床诊治及预后分析

Prognosis and therapy of patient with renal cell carcinoma accompanied with venous tumor thrombus

目的探究肾癌伴下腔静脉瘤栓患者临床特点及预后情况。方法回顾性分析2002年6月至2014年5月天津医科大学第二医院收治56例肾癌伴下腔静脉瘤栓患者，其中下腔静脉I级瘤栓28例，Ⅱ级瘤栓15例，Ⅲ级瘤栓9例，Ⅳ级瘤栓4例；所有患者均行肾肿瘤切除术及瘤栓取出术，并对其进行随访。结果56例患者中，男46例，女10例；年龄42—83岁，平均61．7岁;肿瘤位于左侧24例，右侧32例；肿瘤最大径2．5—14cm，平均6．2cm。临床表现腰疼21例，无痛性血尿18例，腰部肿块1例，其余16例为体检发现；患者术后病理结果透明细胞癌39例，乳头状细胞癌9例，嫌色细胞癌3例，集合管癌、未分类癌各1例，肾癌伴肉瘤样分化3例。43例患者得到随访，随访2～90个月，中位20．4个月；患者中位生存期47个月，五年生存率为45．2％。早期静脉瘤栓（肝静脉以下）患者生存时间显著长于晚期瘤栓（肝静脉以上）患者[（55．3±4．9）个月与（24．8±5．3）个月，P=0．047）]。结论肾癌伴下腔静脉瘤栓患者临床分期晚，预后相对不良。手术治疗仍然是肾癌伴下腔静脉瘤栓患者的首选方式。早期瘤栓患者术后生存情况显著优于晚期瘤栓患者。

Objective To investigate the clinical features and prognosis of the patients with renal Cell carcinoma and venous tumor thrombus. Methods Fifty-six patients with renal cell carcinoma and venous tumor thrombus were selected as our subjects, who underwent radical nephrectomy and thrombectomy in the Second Hospital of Tianjin Medical University from June 2002 to May 2014. There were 28 patients with stage Ⅰ tumor thrombus, 15with stage Ⅱ tumor thrombus,9 with stage Ⅲ tumor thrombus and 4 with stagelVtumor thrombus. All patients underwent renal tumor resection and embolectomy, and were follow-up. Results Of all the patients,46 were male and 10 were female with a mean age of 61.7 （ age ranging from 42 to 83）. Twenty-four were presented on the left kidney and 32 were right. The clinical features were as follows ： The tumor size was 2.5 to 14 cm in diameter（mean： 6.2 cm）, there were 21 cases with low back pain, 18 cases with hematuria, lcases with abdominal. Pathological results showed that 39 with clear cell carcinoma,9 with papillary cell carcinoma,3 with chromophobe cell carc!noma, 1 with low-differentiated cell carcinoma and 1 with undifferentiated cell carcinoma, 3 with sarcomatoid differentiation. Forty-three patients were followed up, and the median follow up period was 20. 4 months（2 -90 months）. The median survival time for the patients was 47 months and the 5 year overall survival was 45.2%. The survival time of the patients with early tumor thrombus（ below hepaticvein） was （55. 3 ± 4. 9） month, significantlydonger than that of the patients with advanced tumor thrombus （ above hepaticvein） （（24. 8 ± 5.3）months, P = 0. 047 ）. Conclusion Patients with renal cell carcinoma and venous tumor thrombus are characterized with high malignancy and poor prognosis. Surgical operations are effective therapies for the patients. Long term outcome of the early tumor thrombus patients is significantly better than that of the advanced tumor.