摘要
目的:分析肾细胞癌骨转移(renal cell carcinoma bone metastasis,RCC-BM)的临床及病理学特点,进一步了解其发生、发展规律。方法:回顾2003年7月至2017年11月间RCC-BM患者的资料,包括患者一般情况,临床与影像学特征,病理学亚型、骨转移灶免疫组织化学染色结果等病理学特征,进行描述性分析和差异性分析。结果:共纳入113例RCC-BM患者进入研究,患者性别比(男∶女)约为4∶1,平均年龄59.39岁。肾癌骨转移灶影像学均表现为溶骨性破坏,常见的骨转移部位为脊柱(46.0%)及骨盆(38.9%),28.3%的RCC-BM患者同时合并其他部位远处转移,46.0%的患者表现为同时性转移[骨转移时间(time to bone metastasis,TTBM)=0],其余表现为异时性转移(TTBM>0),异时性转移患者的中位TTBM为48个月。113例患者中94.7%为肾透明细胞癌骨转移。对104例患者的骨转移病灶进行免疫组织化学染色检查,同时性RCC-BM患者骨转移灶的血管内皮生长因子(vascular endothelial growth factor,VEGF)阳性率与异时性RCC-BM患者相比有升高趋势(P=0.097),碳酸酐酶(carbonic anhydrase,CA)-Ⅸ阳性率有降低趋势(P=0.100);肾透明细胞癌骨转移灶的表皮生长因子受体(epidermal growth factor receptor,EGFR)阳性率显著高于非透明细胞肾癌的骨转移灶(P<0.05)。结论:RCC-BM中男性、中青年患者较多,约80%骨转移发生于脊柱、骨盆等中轴骨部位。不同TTBM亚组间CA-Ⅸ阳性率存在一定差异,可预测RCC-BM预后。VEGF阳性率在同时性RCC-BM亚组中有增高趋势,EGFR阳性率在透明细胞癌亚组中显著增高,可能给RCC-BM的诊断、预后分析、靶向治疗抉择等提供参考。
Objective: To analyze the clinical and pathological characteristics of renal cell carcinoma bone metastasis( RCC-BM) patients. Methods: Data of RCC-BM patients from July 2003 to November2017 were retrospectively reviewed. The patients' baseline characteristics( age,gender),tumor characteristics [specific sites of bone metastasis,time to bone metastasis( TTBM),imaging features of bone disease,coexistence of other metastasis],as well as pathological features( histological classification of primary and bone metastasis,immunohistochemical stain results) were collected. Descriptive analysis and difference analysis were used. Results: A total of 113 RCC-BM patients were enrolled with the gender ratio( male ∶ female) of 4 ∶ 1,mean age of 59. 39 years,and all present of osteolysis bone lesions.The common sites of bone metastasis were vertebra( 46. 0%) and pelvis( 38. 9%). Other distant metastasis sites coexisted in 28. 3%,while 48. 18% RCC-BM patients presented with synchronous metastasis( TTBM = 0). The median TTBM for metachronous metastasis was 48 months. The majority in this cohort were determined to have primary tumor of clear cell carcinoma. After immunohistochemical examination to 104 RCC-BM patients and sub-group analysis,tendencies of higher positive rates of vascular endothelial growth factor( VEGF) was also found in synchronous group( P = 0. 097) while tendencies of higher positive rates of carbonic anhydrase( CA)-Ⅸ was found in the same group( P = 0. 100). The patients with clear cell RCC-BM had a significantly higher positive expression of epithelial growth factor receptor( EGFR,P 〈0. 05) than those with non-clear cell RCC-BM group. Conclusion: More male and younger patients with metastatic lesions in axial skeleton were found in this cohort. Tendencies in the expression of CA-Ⅸ and VEGF in different TTBM sub-group and EGFR in different histology-derived subgroup indicate that they might be associated with risk and prognostic factors and support further target therapies of RCC-BM.
作者
黄子雄
杜依青
张晓鹏
刘士军
徐涛
HUANG Zi-xiong;DU Yi-qing;ZHANC Xiao-peng;LIU Shi-jun;XU Tao(Department of Urology,Peking University People's Hospital,Beijing 100044,China)
出处
《北京大学学报(医学版)》
CAS
CSCD
北大核心
2018年第5期811-815,共5页
Journal of Peking University:Health Sciences
关键词
肾细胞癌
肿瘤转移
骨
临床病理学
Renal cell carcinoma
Neoplasm metastasis
Bones
Clinical pathology