肾细胞癌骨转移的临床与病理分析

Clinical and pathological analysis of renal cell carcinoma bone metastasis

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.