散发性双肾癌的临床病理特征及手术疗效分析

Clinicopathological features and surgical management of sporadic bilateral renal cell carcinoma

目的 探讨散发性双肾癌的临床病理特征、外科处理效果及预后相关因素.方法 回顾性分析2006年1月至2013年12月治疗的79例散发性双侧肾细胞癌患者的临床病理及随访资料.男56例,女23例;年龄25～ 74岁,平均52岁.同时性双肾癌64例,异时性双肾癌15例,均无家族病史.T1期肿瘤68例,T2期肿瘤8例,T3期肿瘤3例.结果 79例患者均行双侧手术治疗,其中34例（43.0％）行双侧保留肾单位手术（nephron-sparing surgery,NSS）,37例（46.8％）行一侧NSS加对侧根治性肾切除术（radical nephrectomy,RN）,6例（7.6％）行一侧RN加对侧射频消融术（radio-frequency ablation,RFA）,1例（1.3％）行一侧NSS对侧RFA,1例（1.3％）行双侧RN.184枚肿瘤中171枚有病理结果,透明细胞癌158枚（92.4％）,乳头状肾细胞癌7枚（4.1％）,嫌色细胞癌4枚（2.3％）,肉瘤样癌2枚（1.2％）.双侧透明细胞癌55例,双侧乳头状肾细胞癌2例.15例伴有一侧肾脏多发病灶（2～6枚）.77例（97.5％）获随访,随访时间9～ 150个月,中位随访时间49个月.59例（76.6％）无瘤生存,9例（11.7％）带瘤生存,9例（11.7％）死亡.患者3年总体生存率为89.8％,3年总体肿瘤无进展生存率为87.1％.多因素分析提示较高的肿瘤核分级（P=0.005）、高肿瘤T分期（P=0.022）是影响预后的独立危险因素,双侧NSS（P=0.157）并未增加肿瘤术后复发的风险.结论 散发性双肾癌的主要病理类型为透明细胞癌,经积极的双侧手术治疗可取得与单侧肾肿瘤相当的预后,NSS为治疗双肾癌的首选方法.

Objective To investigate the clinicopathological features,the efficacy of surgical strategies and the prognostic factors of sporadic bilateral renal cell carcinoma.Methods A total of 79 patients treated from January 2006 to December 2013 were included in the retrospective study.Of the 79 patients,56 were males,23 were females; the mean age was 52 （25-74） years.Sixty-four were bilateral synchronous renal cell carcinoma and 15 were bilateral metachronous renal cell carcinoma,none of these cases had family history.Clinical stages were T1 in 68 cases,T2 in 8 cases,T3 in 3 cases.Results All of the 79 patients underwent bilateral surgeries,of which bilateral nephron-sparing surgery （NSS） was performed in 34 （43.0%） patients,NSS-radical nephrectomy （RN） in 37 （46.8%）,RN-radio-frequency ablation （RFA） in 6 （7.6%）,NSS-RFA in 1 （1.3%）,and bilateral RN in 1 （1.3%）.There were 184 tumors in the 79 patients.Of the 171 tumors with pathological results,158 （92.4%） tumors were clear cell subtype,7 （4.1%） papillary,4 （2.3%） chromophobe and 2 （1.2%） sarcoid.Bilateral clear cell renal cell carcinoma was found in 55 patients and bilateral papillary renal cell carcinoma in 2 patients.Fifteen patients presented with multifocal tumors in one kidney.Seventy-seven （97.5%） patients were followed up and the median follow up period was 49 （9-150） months.In the most recent follow up,59 （76.6%） patients survived without tumors,9 （11.7%） patients survived with tumors,9 （11.7%） patients died.The 3-year overall survival rate and 3-year progress free survival rate were 89.8% and 87.1%,respectively.The higher nuclear grade and higher T stage were related to worse prognosis with the P=0.005 and P=0.022 in multivariate analysis,respectively.Bilateral NSS did not increase the risk of disease progress （P=0.157）.Conclusions Clear cell carcinoma is the main subtype of bilateral sporadic renal carcinoma.NSS is the preferred choice for bilateral kidney tumors.Patients with sporadic bilateral renal tumors underwent active surgeries on both kidneys could get comparable oncological results with that of patients with unilateral renal tumors.