254例肾细胞癌的诊治及预后

Diagnosis,treatment and prognosis of 254 cases of renal cell carcinoma

目的 探讨肾癌的临床诊治方法及预后。方法 对本院 1993年 1月～ 2 0 0 1年 12月收治的 2 5 4例肾癌临床资料进行回顾性分析及随访。结果 典型肾癌“三联征”的发生率为 2 .4 % ;肾癌偶发癌占 4 5 .7%。“肾外表现”主要有 :贫血 4 0 .9% ,消瘦 14 .6 % ,发热 12 .6 % ,高血压 10 .2 %。病程 <3个月占 73.6 % ( 187/ 2 5 4 )。辅助检查以B超、CT为主。治疗以肾癌根治术为主 ,占 87.4 % ,术后结合干扰素治疗 ,效果确切。术后 3年、5年生存率分别为 78.7%、72 .9%。预后多因素分析结果表明 ,肾癌的预后与肿瘤分期、直径大小和C erbB2阳性与否相关。结论 临床上无任何表现而体检偶发的肾癌日渐增多 ,典型的肾癌“三联征”已少见。综合分析患者的病史、体检 ,结合辅助检查 ,有助于肾癌的早期诊断 ,适当条件下的健康体检有积极意义。治疗仍以肾癌根治术为主 ,术后免疫治疗有积极的意义。肿瘤分期、直径大小和C

Objective To explore the diagnosis, treatment and prognosis of renal cell carcinoma(RCC). Methods Two hundred fifty four cases of RCC in our hospital from Jun. 1993 to Dec. 2001 were reviewed. All patients were followed up to assess survival rate. Results The classically described triad(gross hematuria, flank pain, and a palpable mass) occured in only 2.4%. while the rate of RCC incidentally detected was 45.7%.So called paraneoplastic syndromes included mainly anemia(40.9%),thin(14.6%),fever( 12.6 %) and hypertension(10.2%). The disease course of 187 cases was less than 3 months (73.6%). The supplementary examinations gave priority to ultrasonography and CT scanning. Radical nephrectomy was the main treatment(87.4%).Administrating interferon after opration showed good results. The 3 year and 5 year cancer specific survival rates were 78.7% and 72.9% respectively. Multivariate analysis showed the prognosis of RCC was related to the clinical stage,the diameter of tumer and the expression of C erbB2. Conclusion The incidentally discovered RCC became more while the classical triad became lesser. Synthetical analysis of symptoms, physical examination and assistant check up helped to eraly detection of RCC. Health check up examination has its active value. Radical nephrectomy with postoperative interferon administration is an effective treatment for RCC.The stage,diameter and the expression of C erbB2 may give useful prognostic information of RCC.