中华泌尿外科杂志
中華泌尿外科雜誌
중화비뇨외과잡지
CHINESE JOURNAL OF UROLOGY
2008年
4期
222-225
,共4页
董柏君%张进%陈勇辉%陈海戈%陈奇%郭三维%宣寒青%薛蔚%周立新%刘东明%黄翼然
董柏君%張進%陳勇輝%陳海戈%陳奇%郭三維%宣寒青%薛蔚%週立新%劉東明%黃翼然
동백군%장진%진용휘%진해과%진기%곽삼유%선한청%설위%주립신%류동명%황익연
肾肿瘤%癌%数据库%病理学
腎腫瘤%癌%數據庫%病理學
신종류%암%수거고%병이학
Kidney neoplasms%Carcinoma%Database%Pathology
目的 探讨肾癌临床、病理、分期、分级与预后特征. 方法 分析2003年至2005年上海仁济医院泌尿科肾癌数据库435例患者临床和病理资料.采用WHO 1997年肾实质上皮性肿瘤组织学分类标准、2002年ATCC的TNM分期和临床分期、1982年Fuhrman病理分级.采用Kaplan-Meier法和Logrank检验对57例获随访的晚期患者行生存分析和预后因素判断. 结果 435例患者中,遗传性VHL病肾癌10例(2.4%)、散发性肾透明细胞癌372例(85.5%)、乳头状癌13例(3.0%)、嫌色细胞癌18例(4.1%)、集合管癌4例(0.9%)、嗜酸性细胞腺瘤4例(0.9 %)、未分类肾癌.14例(3.2%).行根治性肾切除术335例(77.0%),保留肾单位手术74例(17.0%),姑息性肾切除等手术26例(6.0%).遗传性VHL病肾癌均为双肾癌伴多发囊肿,临床分期Ⅰ期7例、Ⅱ期3例,病理分级Ⅰ级6例、Ⅱ级4例,基因测序均存在VHL基因突变,平均随访28.6个月,患者无肿瘤局部进展或转移,但4例患者出现同侧或双侧肿瘤再发.嫌色细胞癌临床分期均为Ⅰ期,病理分级Ⅰ级5例,Ⅱ级13例,平均随访19.8个月均存活,无肿瘤转移或复发.集合管癌临床分期均为Ⅰ期,病理分级均为Ⅲ级,平均生存时间11.3个月.肾透明细胞癌和乳头状癌临床分期Ⅰ期260例(67.6%)、Ⅱ期64例(16.6%)、Ⅲ期32例(8.3%)、Ⅳ期29例(7.5%),其中T1a 147例(38.2%)、T1b 113例(29.4 %);病理分级Ⅰ级124例(32.2%)、Ⅱ级219例(56.9%)、Ⅲ级40例(10.4%)、Ⅳ级2例(0.5%).57例晚期肾癌患者中位生存时间(16.0±1.3)个月,1年生存率55.0%,2年生存率31.0%.预后因素分析显示,临床分期、肿瘤大小、淋巴结转移、远处转移和病理分级是晚期肾癌解剖水平和组织学水平的预后影响因素. 结论 不同组织学亚型的肾癌生物学特征存在较大差异,遗传性VHL病肾癌存在基因突变,常为双侧、多中心、低Fuhrman分级透明细胞癌,易再发不易转移.肾嫌色细胞癌预后较好,而集合管癌预后差.在解剖水平和组织学水平,TNM分期、肿瘤大小、淋巴结转移、远处转移和肾癌病理分级是晚期肾癌的预后影响因素.
目的 探討腎癌臨床、病理、分期、分級與預後特徵. 方法 分析2003年至2005年上海仁濟醫院泌尿科腎癌數據庫435例患者臨床和病理資料.採用WHO 1997年腎實質上皮性腫瘤組織學分類標準、2002年ATCC的TNM分期和臨床分期、1982年Fuhrman病理分級.採用Kaplan-Meier法和Logrank檢驗對57例穫隨訪的晚期患者行生存分析和預後因素判斷. 結果 435例患者中,遺傳性VHL病腎癌10例(2.4%)、散髮性腎透明細胞癌372例(85.5%)、乳頭狀癌13例(3.0%)、嫌色細胞癌18例(4.1%)、集閤管癌4例(0.9%)、嗜痠性細胞腺瘤4例(0.9 %)、未分類腎癌.14例(3.2%).行根治性腎切除術335例(77.0%),保留腎單位手術74例(17.0%),姑息性腎切除等手術26例(6.0%).遺傳性VHL病腎癌均為雙腎癌伴多髮囊腫,臨床分期Ⅰ期7例、Ⅱ期3例,病理分級Ⅰ級6例、Ⅱ級4例,基因測序均存在VHL基因突變,平均隨訪28.6箇月,患者無腫瘤跼部進展或轉移,但4例患者齣現同側或雙側腫瘤再髮.嫌色細胞癌臨床分期均為Ⅰ期,病理分級Ⅰ級5例,Ⅱ級13例,平均隨訪19.8箇月均存活,無腫瘤轉移或複髮.集閤管癌臨床分期均為Ⅰ期,病理分級均為Ⅲ級,平均生存時間11.3箇月.腎透明細胞癌和乳頭狀癌臨床分期Ⅰ期260例(67.6%)、Ⅱ期64例(16.6%)、Ⅲ期32例(8.3%)、Ⅳ期29例(7.5%),其中T1a 147例(38.2%)、T1b 113例(29.4 %);病理分級Ⅰ級124例(32.2%)、Ⅱ級219例(56.9%)、Ⅲ級40例(10.4%)、Ⅳ級2例(0.5%).57例晚期腎癌患者中位生存時間(16.0±1.3)箇月,1年生存率55.0%,2年生存率31.0%.預後因素分析顯示,臨床分期、腫瘤大小、淋巴結轉移、遠處轉移和病理分級是晚期腎癌解剖水平和組織學水平的預後影響因素. 結論 不同組織學亞型的腎癌生物學特徵存在較大差異,遺傳性VHL病腎癌存在基因突變,常為雙側、多中心、低Fuhrman分級透明細胞癌,易再髮不易轉移.腎嫌色細胞癌預後較好,而集閤管癌預後差.在解剖水平和組織學水平,TNM分期、腫瘤大小、淋巴結轉移、遠處轉移和腎癌病理分級是晚期腎癌的預後影響因素.
목적 탐토신암림상、병리、분기、분급여예후특정. 방법 분석2003년지2005년상해인제의원비뇨과신암수거고435례환자림상화병리자료.채용WHO 1997년신실질상피성종류조직학분류표준、2002년ATCC적TNM분기화림상분기、1982년Fuhrman병리분급.채용Kaplan-Meier법화Logrank검험대57례획수방적만기환자행생존분석화예후인소판단. 결과 435례환자중,유전성VHL병신암10례(2.4%)、산발성신투명세포암372례(85.5%)、유두상암13례(3.0%)、혐색세포암18례(4.1%)、집합관암4례(0.9%)、기산성세포선류4례(0.9 %)、미분류신암.14례(3.2%).행근치성신절제술335례(77.0%),보류신단위수술74례(17.0%),고식성신절제등수술26례(6.0%).유전성VHL병신암균위쌍신암반다발낭종,림상분기Ⅰ기7례、Ⅱ기3례,병리분급Ⅰ급6례、Ⅱ급4례,기인측서균존재VHL기인돌변,평균수방28.6개월,환자무종류국부진전혹전이,단4례환자출현동측혹쌍측종류재발.혐색세포암림상분기균위Ⅰ기,병리분급Ⅰ급5례,Ⅱ급13례,평균수방19.8개월균존활,무종류전이혹복발.집합관암림상분기균위Ⅰ기,병리분급균위Ⅲ급,평균생존시간11.3개월.신투명세포암화유두상암림상분기Ⅰ기260례(67.6%)、Ⅱ기64례(16.6%)、Ⅲ기32례(8.3%)、Ⅳ기29례(7.5%),기중T1a 147례(38.2%)、T1b 113례(29.4 %);병리분급Ⅰ급124례(32.2%)、Ⅱ급219례(56.9%)、Ⅲ급40례(10.4%)、Ⅳ급2례(0.5%).57례만기신암환자중위생존시간(16.0±1.3)개월,1년생존솔55.0%,2년생존솔31.0%.예후인소분석현시,림상분기、종류대소、림파결전이、원처전이화병리분급시만기신암해부수평화조직학수평적예후영향인소. 결론 불동조직학아형적신암생물학특정존재교대차이,유전성VHL병신암존재기인돌변,상위쌍측、다중심、저Fuhrman분급투명세포암,역재발불역전이.신혐색세포암예후교호,이집합관암예후차.재해부수평화조직학수평,TNM분기、종류대소、림파결전이、원처전이화신암병리분급시만기신암적예후영향인소.
Objective To study the histological classification,clinical stage,histological grade and prognosis of renal cell carcinoma by analyzing the records of the patients in Shanghai Renji hospital. Methods A consecutive series of 435 patients with renal cell carcinoma between 2003 and 2005derived from the renal cancer database were reviewed clinically and pathologically.The 1997 version of WHO histological classification for renal epithelial tumor,the 2002 version of AJCC clinical TNM staging system and the 1982 version of Fuhrmaffs system for nuclear grade were used.By survival analysis of 57 cases with advanced renal cell carcinoma using Kaplan-Meier method prognostic factors were confirmed using logrank test. Results Of a total 435 patients,cases were classified into 10(accounting for 2.4%of renal cell tumors)hereditary renal cancer in VHL disease,372(85.5%)clear cell renal cell carcinoma(CCRCC),13(3.0%)papillary renal cell carcinoma(PRCC),18(4.1%)chromophobe renal cell carcinoma(CRCC),4(0.9%)oncocytoma,4(0.9%)carcinoma of the collecting ducts of Bellini(CCDB),and 14(3.2%)renal cell carcinoma unclassified.There were 335(77%)patients undergone radical nephrectomy,74(17%)nephron sparing surgery and 26(6%)others,such as palliative nephrectomy.The patients with VHL disease come from 5 Chinese kindred and all had bilateral clear cell renal cell carcinomas and multifocal renal cysts.There were 7 paients of stage Ⅰ and 3 cases of stage Ⅱ and 6 cases of grade Ⅰ and 4 cases of grade Ⅱ.Genetic test revealed that all patients had VHL gene mutation.4 patients had recurrence while no evidence of local advance and distant metastasis were found during a mean of 28.6 months.Patients with chromophobe RCC are all of stage Ⅰ and 5 cases of grade Ⅰ and 13 cases of gradeⅡ.All patients are alive without recurrence or metastasis during a mean of 19.8 months.Collecting ducts RCC all presented with stage Ⅰ but grade Ⅲand with the median survival only 11.3 Months.Of clear cell and papillary RCC,260(67.6%),64(16.6%),32(8.3 %),29(7.5%)were stage Ⅰ,Ⅱ,Ⅲand Ⅳ,and of stage Ⅰ patients 147(38.2%),113(29.4%)were T1a and T1b respectively.124(32.2%),219(56.9%),40(10.4)and 2(0.5%)were grade Ⅰ,Ⅱ,Ⅲ,Ⅳ,respectively.Median survival of 57 advanced RCC is 16.0±1.3months,1-year survival is 55%,and 2-year survival is 31%,respectively.By using logrank test,clinical stage(＜0.01),tumor size(＜0.01),lymphadenopathy(＜0.01),metastasis(＜0.01)and tumor grade(＜0.01)were anatomical and histological prognostic factors for advanced RCC. Coneluslons Different RCC subtypes have different clinical course.The RCC patients in VHL disease have VHL gene mutation and the tumors are often multifocal,bilateral,clear cell type with a low stage and grade which often recurrence but without metastasis.Chromophobe RCC may have a favorable prognosis but collecting duct RCC poor prognosis.In anatomical and histological level,clinical stage,tumor size,lymphadenopathy,metastasis and tumor grade are prognostic factors of survival for advanced RCC.
