术后局部复发肾癌的临床病理特点及二次手术治疗效果研究

Study on the clinicopathological characteristics of postoperative locally recurrent renal cell carcinoma and the therapeutic effect of secondary surgery

目的探讨术后局部复发肾癌的临床病理特点及二次手术治疗效果。方法回顾性分析300例术后局部复发肾癌患者的临床及病理资料,分析患者的复发情况及复发患者临床病理特点和二次治疗效果。结果300例患者均顺利出院,无围术期死亡病例,其中肾部分切除151例,根治性肾切除149例;随访17~24个月,平均随访(20.45±1.19)个月;复发24例,复发率为8%;复发时间11~18个月,平均复发时间(15.21±1.41)个月。24例复发患者中,男性、透明细胞癌、原发灶TNM分期PN1M0的占比均较高。24例复发患者中,21例进行二次切除术及靶向药物(多吉美)治疗,3例仅给予靶向药物(多吉美)治疗。术后完成随访22例,随访率为91.67%;随访过程中,1例发生再次复发,复发率为4.55%(1/22);二次手术后,1年无瘤生存19例,3年无瘤生存12例。结论对于肾癌术后局部复发患者,二次手术是可行的,临床应根据病理结果及时治疗,延缓患者的进展。

Objective To discuss the clinicopathological characteristics of postoperative locally recurrent renal cell carcinoma and the therapeutic effect of secondary surgery.Methods The clinical and pathological data of 300 patients with postoperative locally recurrent renal cancer were retrospectively analyzed,and the recurrence of the patients and the clinicopathological characteristics of the recurrent patients and the effects of secondary surgery were analyzed.Results All 300 patients were discharged successfully,with no perioperative deaths,including 151 cases of partial nephrectomy and 149 cases of radical nephrectomy;follow-up ranged from 17 to 24 months,with a mean follow-up of(20.45±1.19)months;24 cases of recurrence,with a recurrence rate of 8%;recurrence time ranged from 11 to 18 months,with a mean recurrence time of(15.21±1.41)months.Among 24 patients with recurrence,males,clear cell carcinoma,and primary tumor TNM stage PN1M0 accounted for a higher proportion.Among the 24 patients with recurrence,21 cases underwent secondary resection and targeted drug(Nexavar)treatment,and 3 cases only received targeted drug(Nexavar)treatment.Postoperative follow-up was completed in 22 cases,with a follow-up rate of 91.67%;during the follow-up,1 case relapsed again,with a recurrence rate of 4.55%(1/22);after the second operation,19 cases survived tumor-free in 1 year,and 12 cases survived tumor-free in 3 years.Conclusion For patients with postoperative locally recurrent renal cell carcinoma,the second surgery is feasible,and clinical treatment should be timely based on the pathological results to slow down their progress.