高危小肾癌的临床病理特点及预后分析

Clinical and pathological characteristics and prognostic evaluation of high-risk small renal carcinoma

目的：分析高危小肾癌（局部进展或同时性肿瘤转移）的临床和病理学特点及其与肿瘤复发、预后的关系，为高危小肾癌的个体化治疗提供理论依据。方法回顾性分析2000年1月至2015年7月经手术治疗的21例高危小肾癌患者的临床病理资料。男15例，女6例。年龄27～75岁，平均（61．5±7．1）岁。肿瘤直径2．0～4．0 cm，平均3．3cm。分析其病理类型、病理分期、Fuhrman分级、肾周组织及静脉侵犯、脉管内瘤栓、远处转移等特点。结果本组21例的病理类型分别为透明细胞癌17例（86．1％），乳头状癌1例（6．5％），混合细胞型2例（恶性横纹肌样瘤和肉瘤样变），肉瘤样癌1例（2．7％）。 FuhrmanⅡ级13例，Ⅲ级5例，Ⅳ级1例。侵犯肾静脉、静脉分支或肾静脉瘤栓7例，侵犯肾周或肾窦脂肪11例，初诊同时发现肺转移3例，局部淋巴结转移3例，脑转移1例。术后临床分期T3a N0 M014例，T1a N1 M03例，T1a N0 M14例。结论小肾癌具有异质性，少数表现为侵袭性生长，可早期侵犯肾周组织甚至转移，肿瘤直径＞3．0 cm，FuhrmanⅢ、Ⅳ级，肉瘤样癌更容易出现进展和转移，手术应根据临床分期采取个体化治疗。

Objective To study clinical and histopathological features of high-risk small renal carcinoma and provide theoretical basis for the individualized treatment.Methods This retrospective study analyzed the clinical and histological data of 21 patients of high-risk small renal cell carcinomas which were highly aggressive or advanced stage, admitted from Jan 2000 to July 2015.There were 15 males and 6 females,and the average age was （61.5 ±7.1） years （ranged 27 to 75 years）.The mean diameter of tumors was 3.3cm （ranged 2.0 to 4cm）.The study mainly focused on pathological character and stage, Fuhrman grading, existence of perirenal tissue or vascular invasion, venous embolus and distant metastasis.Results Of all these 21 cases, 17 cases were clear cell carcinomas, 1 was papillary carcinoma, 2 were hybrid cellular tumor （ malignant rhabdoid tumor and sarcomatoid carcinoma） and 1 was sarcomatoid carcinoma. Among the 17 clear cell carcinoma cases, 12 were Fuhrman grade Ⅱ, 5 were grade Ⅲ and one was gradeⅣ.Tumor infiltrated renal vein or its branches and renal vein embolus were found in 7 cases.The tumor infiltrated perirenal or renal sinus fat were found in 11 cases.Synchronous lung and local lymph nodes metastasis were found in 3 patients respectively.Moreover, there was 1 case with metastasis to the brain （FuhrmanⅣ）.The final clinical stage were T3a N0M0 in 14,T1a N1M0 in 3 and T1a N0M1 in 4 cases. Conclusions Small renal tumors are heterogeneous in its biological behavior and the minorities are aggressive with infringement of perirenal fat or simultaneous local lymph node or distant metastasis.When the tumor is greater than 3.0 cm in diameter and with high grade in Fuhrman classification, sarcomatoid carcinoma are more likely to be highly aggressive and advanced stage.