CAJ | 학술논문

肾癌临床病理特点和治疗变化——上海仁济医院1999-2010年资料分析
신암림상병리특점화치료변화——상해인제의원1999-2010년자료분석
Changing trend of renal cell carcinoma from 1999 to 2010 : a single center experience

万方数据

中华泌尿外科杂志中華泌尿外科雜誌 중화비뇨외과잡지
CHINESE JOURNAL OF UROLOGY
2012年 12期 891-894 ,共4页

张进%董柏君%孔文%陈勇辉%黄吉炜%陈奇%陈海戈%李东%薄隽杰%周立新%薛蔚%刘东明%黄翼然

장진%동백군%공문%진용휘%황길위%진기%진해과%리동%박준걸%주립신%설위%류동명%황익연

肾肿瘤%癌%保留肾单位手术腎腫瘤%癌%保留腎單位手術
신종류%암%보류신단위수술
Kidney neoplasms%Carcinoma%nephron-sparing surgery

目的探讨上海仁济医院12年收治肾癌病例临床病理特点和治疗方法的变化. 方法回顾性分析1999-2010年诊治1923例肾癌患者资料,包括初诊年龄、性别、症状、肿瘤大小、TNM分期、病理亚型、Fuhrman分级及手术方式.将临床资料分3个阶段进行比较分析:第1阶段(1999-2002年)以开放根治手术为主；第2阶段(2003-2006年)保留肾单位手术及腹腔镜手术逐步应用；第3阶段(2007-2010年)保留肾单位手术广泛应用. 结果 1999-2010年,收治肾癌例数明显增加,由第1阶段267例增至第3阶段1092例.无症状肾癌患者比例由49.8％增至73.6％(P＜0.01),但男女比例(P=0.559)、平均初诊年龄.(P=0.138)和青年肾癌(≤40岁)比例(P=0.604)无明显变化.肿瘤平均最大径由6.1 cm降至4.8 cm(P ＜0.01),小肾癌(≤4 cm)比例由30.3％(81例)增至54.4％(594例,P＜0.01).开放手术比例由98.5％(263例)降至73.8％(806例),腹腔镜手术比例由1.5％(4例)升至26.2％(286例,P＜0.01)；根治手术比例由94.8％(253例)降至62.8％(686例)；保留肾单位手术比例由5.2％(14例)升至34.7％(379例,P＜0.01),其中T1a期保留肾单位手术比例由17.9％(14例)升至57.4％(323例,P＜0.01).T1b期由0.0％升至14.8％(50例,P＜0.01).第3阶段开展了肾癌的射频消融治疗占2.5％(27例). 结论 1999-2010年肾癌的临床特点及治疗手段已发生变化,肾癌就诊率明显增加,无症状肾癌和小肾癌明显增多,T1a期保留肾单位手术逐渐部分取代根治手术,部分T1a期肿瘤采取射频消融治疗,T1b期肾癌采取保留肾单位手术的例数增加.
목적 탐토상해인제의원12년수치신암병례림상병리특점화치료방법적변화. 방법 회고성분석1999-2010년진치1923례신암환자자료,포괄초진년령、성별、증상、종류대소、TNM분기、병리아형、Fuhrman분급급수술방식.장림상자료분3개계단진행비교분석:제1계단(1999-2002년)이개방근치수술위주；제2계단(2003-2006년)보류신단위수술급복강경수술축보응용；제3계단(2007-2010년)보류신단위수술엄범응용. 결과 1999-2010년,수치신암례수명현증가,유제1계단267례증지제3계단1092례.무증상신암환자비례유49.8％증지73.6％(P＜0.01),단남녀비례(P=0.559)、평균초진년령.(P=0.138)화청년신암(≤40세)비례(P=0.604)무명현변화.종류평균최대경유6.1 cm강지4.8 cm(P ＜0.01),소신암(≤4 cm)비례유30.3％(81례)증지54.4％(594례,P＜0.01).개방수술비례유98.5％(263례)강지73.8％(806례),복강경수술비례유1.5％(4례)승지26.2％(286례,P＜0.01)；근치수술비례유94.8％(253례)강지62.8％(686례)；보류신단위수술비례유5.2％(14례)승지34.7％(379례,P＜0.01),기중T1a기보류신단위수술비례유17.9％(14례)승지57.4％(323례,P＜0.01).T1b기유0.0％승지14.8％(50례,P＜0.01).제3계단개전료신암적사빈소융치료점2.5％(27례). 결론 1999-2010년신암적림상특점급치료수단이발생변화,신암취진솔명현증가,무증상신암화소신암명현증다,T1a기보류신단위수술축점부분취대근치수술,부분T1a기종류채취사빈소융치료,T1b기신암채취보류신단위수술적례수증가.
Objective To study the evolution of renal cell carcinoma treated in a single institution over the past 12 years.Methods A total of 1923 patients with renal cell carcinoma surgically treated from 1999 to 2010 were included in this study.Age at diagnosis,gender,symptoms,tumor size,TNM stage,histological subtype,Fuhrman grade and type of treatment were compared among 3 periods (Period 1:1999-2002,Period 2:2003-2006,Period 3:2007-2010).Results The number of patients grew fasty from 267 cases in the Period 1 to 1092 cases in the Period 3.The incidentally diagnosed cases increased significantly from 49.8％ to 73.6％ (P ＜0.01),while the mean age of patients at diagnosis,the male to female ratio and the proportion of young (＜40 years old) patients were not statistically different.The tumor size at diagnosis gradually decreased from 6.1 cm to 4.8 cm (P ＜ 0.01),and the proportion of small tumors less than 4 cm increased remarkably from 30.3％ to 54.4％ (P ＜ 0.01).Concerning the surgical approach,open surgery decreased from 98.5％ to 73.8％ (P ＜ 0.01),and laparoscopic surgery increased from 1.50％ to 26.2％ (P ＜ 0.01).Overall,the rate of nephron-sparing surgery increased from 5.2％ to 34.7％ (P ＜0.01) in all cases.The use of nephron-sparing surgery increased significantly from 17.9％ to 54.7％ in T1a subset and from 0.00％ to 14.8％ in T1b subset respectively (P ＜ 0.01).Furthermore,radiofrequency ablation was applied and the percent of this approach reached 2.47％ in Period 3.Conclusions The evolution of clinical-pathological characteristics and surgical treatment for renal cell carcinoma in a single institution is apparent over the last 12 years.With the increase of incidentally diagnosed cases and small renal tumors,nephron-sparing surgery has been widely performed in T1 subset instead of traditional radical nephrectomy.