乳头状肾癌的临床病理特征及预后分析

Clinicopathologic and prognostic analysis of papillary renal cell carcinoma

目的总结乳头状肾癌的临床病理特征，分析其预后相关因素。方法2001年8月至2013年2月收治肾癌患者1005例，其中手术治疗的乳头状肾癌患者72例（7．2％），男60例，女12例。中位年龄50岁（21—75岁）。肿瘤中位直径5．8cm（0．5～24．0cm）。52例无症状；20例有症状者中血尿14例，腰痛6例。行开放手术63例（87．5％），腹腔镜手术9例（12．5％）。行根治性肾切除术48例（66．7％），肾部分切除术24例（33．3％）。总结乳头状肾癌患者的临床病理特征和生存情况，使用Cox比例风险模型分析与乳头状肾癌预后相关的临床病理因素。结果术后病理检查发现区域淋巴结转移16例，远处转移2例。病理分型：I型11例（15．3％），Ⅱ型61例（84．7％）。11例I型的Fuhrman分级均为I级；61例Ⅱ型的Fuhrman分级为Ⅱ级36例，Ⅲ级15例，Ⅳ级10例。中位随访时间35个月（7—146个月），10例死于肾癌，1例死于心力衰竭，余61例存活。本组72例总的5年肿瘤特异性生存率为78．6％（10例死亡），其中I型的5年肿瘤特异性生存率为100．0％，Ⅱ型为75．5％（10例死亡）。Fuhrman分级I一Ⅳ级患者的5年肿瘤特异性生存率分别为100．0％（无死亡）、83．5％（4例死亡）、78．8％（2例死亡）和31．3％（4例死亡）。多因素Cox比例风险回归模型分析发现肿瘤直径（HR=1．141，P=0．019）和Fuhrman分级（HR=3．034，P=0．004）是本组乳头状肾癌患者的独立预后因素。结论与I型乳头状肾癌相比，Ⅱ型乳头状肾癌的恶性程度较高，预后较差。本组乳头状肾癌患者的肿瘤直径和Fuhrman分级是肿瘤特异性生存率的独立预测因子。

Objective The aim of this study is to summarize the clinicopathologic characters and factors associated with prognosis of papillary renal cell carcinoma. Methods We treated 72 papillary renal cell carcinoma by surgery from August 2001 to February 2013, which account for 7.2% of all renal cancer patients （72/1005 eases）. There were 60 male and 12 female patients included in this study, with a median age of 50 （ ranging from 21-75）. The median tumor diameter was 5.8cm（ ranging from 4 to 8cm）. Fifth-two patients were asymptomatic, 14 patients presented with hematuria and 6 presented with backache. In the 72 patients, 63 received （87.5%） open surgery and 9 cases （12. 5% ） underwent laparoscopic surgery. Forty- eight patients （66. 7% ） were treated with radical nephrectomy and 24 patients （33.3%） were treated with partial nephreetomy. In the current study, we summarized the clinical and pathological records and follow-up data. Cox regression analysis were performed to identify the independent predictors for cancer specific survival. Results Local lymph nodes were involved in 16 cases and distal metastasis was found in 2 cases. There were 11 cases （15. 3% ） of type I papillary renal cell carcinoma and 61 cases （84. 7% ）of type Ⅱ. All type I cases were determined as Fuhrman grade I and all type Ⅱ tumor were determined as Fuhrman gradeⅡ-IV, including grade II in 36 cases, grade Ⅱ in 15 cases and grade IV in 30 cases. With a median follow-up duration of 35 months （ranging from 7 to 146 months）, 10 patients died due to renal cancer, 1 died due to heart failure and the rest 61 was alive. The cancer specific survival at five years for the whole group was 78.6% （ 100. 0% in type I and 75.5% in type Ⅱ ）. The 5 year cancer specific survival rate for patients with Fuhrman grade I -IV was 100. 0% ,83.5% ,78.8% and 31.3%, respectively. Cox regressionanalysis revealed that tumor diameter （ hazard ratio 1. 141, P = 0. 019） and Fuhrman grade （ hazard ratio 3. 034, P = 0. 004） were independent prognostic factors for cancer specific survival. Conclusions Type I1 papillary renal cell carcinoma has more aggressive characters and poorer prognosis compared with type I .Tumor diameter and Fuhrman grade were independent prognostic factors for cancer specific survival.