维持性血液透析并发肾癌的临床病理特点

Clinicopathological characteristics of renal cell carcinoma complicated by maintenance hemodialysis

目的:探讨维持性血液透析并发肾癌的临床病理特点及预后。方法:回顾性分析我院2013年01月至2020年01月收治的10例维持性血液透析并发肾癌患者的临床病理资料,并与同期肾功能正常肾癌患者比较。结果:男6例,女4例;平均年龄49.4(31~63)岁,维持血透时间平均49.6(19~62)个月。3例患者存在获得性肾囊肿。临床表现为肉眼血尿1例,其余9例无肾肿瘤临床症状。肿瘤均单侧单发。肿瘤最大径平均为3.9(1.2~5.4) cm。仅1例血尿患者临床分期T3aN0M0,余9例临床分期T1N0M0。患者均行后腹腔镜根治性肾切除术。术后病理证实为肾透明细胞癌9例(90%),乳头状肾细胞癌1例(10%)。相较肾功能正常肾癌患者,维持性血液透析并发肾癌患者具有年轻、瘤体小和分级低的特点(P<0.05),且平均随访64.7(26~104)个月,患者均存活,未见肿瘤复发及远处转移。结论:维持性血液透析并发肾癌患者具有较好的临床病理结果,积极手术治疗预后好。维持性血液透析患者需警惕并发肾癌的风险,由于患者大多无临床症状,故需定期筛查。

Objective:To explore the clinicopathological characteristics and prognosis in maintenance hemodialysis(MHD) patients with renal cell carcinoma(RCC).Methods:We retrospectively analyzed the clinicopathological data of 10 patients with renal cell carcinoma complicated by MHD admitted to our hospital from January 2013 to January 2020,and compared them with RCC patients with normal renal function during the same period.Results:There were 6 males and 4 females, with an average age of 49.4(31~63) years old.The mean duration of hemodialysis before a diagnosis of RCC was 49. 6(19 ~ 62) months. In 3 patients,RCC was accompanied by acquired cystic kidney disease(ACKD). Only 1 patient presented with gross hematuria,and the other 9 patients were asymptomatic. Tumors were unilateral and solitary. The mean largest dimension of the tumor was 3. 9(1. 2 ~ 5. 4) cm. Only 1 patient with hematuria had T3aN0M0disease,the remaining 9 patients had T1N0M0. All the patients underwent retroperitoneal laparoscopic radical nephrectomy. Postoperative pathology showed RCC in all 10 patients. Clear cell carcinoma occurred in 9 patients(90%),and papillary RCC in 1 patient(10%). Compared to RCC patients with normal renal function,MHD-complicated RCC patients were younger,had smaller tumors,and had lower WHO/ISUP grading(P< 0. 05). 10 patients were followed up for 26 ~ 104 months,with a median follow-up of 64. 7(26 ~ 104) months. All the patients survived,and no recurrence or metastasis was found.Conclusion:RCC arising in MHD patients exhibit many favorable clinical and pathologic features,and a good prognosis can be achieved after active surgical treatment. Patients undergoing MHD need to be alert to the risk of concurrent RCC and need to be screened regularly as most patients have no clinical symptoms.