CAJ | 학술논문

目的：评估外科治疗散发性、无转移双侧肾细胞癌的效果。方法回顾性研究2000年1月至2010年1月中国医学科学院肿瘤医院收治的经病理证实的散发性、无转移、双侧肾细胞癌患者的临床、病理及随访资料，评估患者5年无瘤生存率及肾功能结果。结果共入组22例散发性、无转移双肾癌患者，占我院同期收治原发肾细胞癌（1696例）的1．3％。同时性发病16例（72．7％），异时性发病6例（27．3％）。同时性双肾癌发病年龄为（54．2±15．6）岁。异时性双肾癌第1与第2肿瘤发病年龄分别为（50．8±10．4）岁和（57．5±12．1）岁。22例患者共发现47枚肾肿瘤，左肾22枚、右肾25（有2例患者右肾发生多灶肿瘤，分别为2、3枚肿瘤）枚。肿瘤直径为（4．3±3．9）cm。47枚肿瘤中，46枚（97．9％）为透明细胞癌，1枚（2．1％）为乳头状肾细胞癌。所有患者均接受分期手术治疗：先行一侧根治性肾切除再行对侧保留肾单位手术（RN＋NSS）10例，先行一侧保留肾单位手术再行对侧根治性肾切除（NSS＋RN）8例，双侧保留肾单位手术（NSS＋NSS）4例。第2次手术后RN＋ NSS组、NSS＋RN组及NSS＋NSS组中患者出现急性肾功能不全的风险分别为60％、25％和0。患者术后平均随访（72±63）个月。同时性双肾癌与异时性双肾癌的5年无瘤生存率分别为81．8％和50％（ P＝0．025）。结论保留肾单位手术治疗是散发性、无转移性双肾癌患者的安全有效的治疗手段，可获得良好的肾功能及肿瘤学结果。虽然多数双肾癌表现为同时性发病，但部分患者可在一侧肾脏手术多年后发生对侧肾脏的异时性肿瘤。并且，异时性双肾癌的无瘤生存率低于同时性双肾癌，这些患者应给予更严密随诊。
목적：평고외과치료산발성、무전이쌍측신세포암적효과。방법회고성연구2000년1월지2010년1월중국의학과학원종류의원수치적경병리증실적산발성、무전이、쌍측신세포암환자적림상、병리급수방자료，평고환자5년무류생존솔급신공능결과。결과공입조22례산발성、무전이쌍신암환자，점아원동기수치원발신세포암（1696례）적1．3％。동시성발병16례（72．7％），이시성발병6례（27．3％）。동시성쌍신암발병년령위（54．2±15．6）세。이시성쌍신암제1여제2종류발병년령분별위（50．8±10．4）세화（57．5±12．1）세。22례환자공발현47매신종류，좌신22매、우신25（유2례환자우신발생다조종류，분별위2、3매종류）매。종류직경위（4．3±3．9）cm。47매종류중，46매（97．9％）위투명세포암，1매（2．1％）위유두상신세포암。소유환자균접수분기수술치료：선행일측근치성신절제재행대측보류신단위수술（RN＋NSS）10례，선행일측보류신단위수술재행대측근치성신절제（NSS＋RN）8례，쌍측보류신단위수술（NSS＋NSS）4례。제2차수술후RN＋ NSS조、NSS＋RN조급NSS＋NSS조중환자출현급성신공능불전적풍험분별위60％、25％화0。환자술후평균수방（72±63）개월。동시성쌍신암여이시성쌍신암적5년무류생존솔분별위81．8％화50％（ P＝0．025）。결론보류신단위수술치료시산발성、무전이성쌍신암환자적안전유효적치료수단，가획득량호적신공능급종류학결과。수연다수쌍신암표현위동시성발병，단부분환자가재일측신장수술다년후발생대측신장적이시성종류。병차，이시성쌍신암적무류생존솔저우동시성쌍신암，저사환자응급여경엄밀수진。
ABSTRACT:Objective To evaluate the efficacy of surgical treatment of sporadic M0 bilateral renal cell carcinoma (BRCC) .Methods The clinical data of cases identified by pathology as sporadic M0 BRCC during 2000 and 2010 in Cancer Institute&Hospital ,Chinese Academy of Medical Sciences were retrospectively analyzed .The 5‐year disease‐free survival and renal function outcomes were reviewed .Results A total of 1 696(1 .3% ) patients surgically treated for RCC had sporadic M0 bilateral disease .Synchronous tumors were found in 16 patients (72 .7% ) and metachronous tumors in 6 (27 .3% ) .Mean age at diagnosis of the synchronous BRCC was 54 .2 ± 15 .6 .Mean age of the metachronous BRCC at diagnosis of the first and second renal cell carcinomas was 50 .8 ± 10 .4 and 57 .5 ± 12 .1 years ,respectively .A total of 47 renal tumors were found in the 22 pa‐tients ,22 tumors were on the left kidney ,and 25 on the right .The mean tumor size was 4 .3 cm in diameter (range:1 .0-12.0 cm) .Of the 47 tumors ,histology was conventional (clear cell) in 46 (97 .9% ) tumors ,papillary in 1 (2 .1% ) .All of these pa‐tients underwent staged surgical procedures (two operations) .The treatment included unilateral radical nephrectomy followed by contralateral nephron sparing surgery (RN plus NSS group ,10 cases) ,unilateral nephron sparing surgery followed by con‐tralateral radical nephrectomy (NSS plus RN group ,8 cases) ,bilateral nephron sparing surgery (NSS plus NSS group ,4 cases) . The risk of acute renal failure in RN plus NSS group ,NSS plus RN group and NSS plus NSS group was 60% ,25% and 0 ,re‐spectively ,after the second surgery .Mean follow‐up time was 72 months (range :25‐150 months) .The 5‐year disease‐free sur‐vival rate in synchronous BRCC and metachronous BRCC was 81 .8% and 50% respectively ( P= 0 .025) .Conclusions Nephron sparing surgery is a safe and effective procedure for the treatment of sporadic M0 bilateral renal cell carcinoma ,resul‐ting in the preservation of renal function and long‐term cancer control .Although most bilateral RCC present synchronously , metachronous lesions may occur many years after original nephrectomy .Disease‐free survival in metachronous bilateral RCC is lower than simultaneous bilateral RCC ,therefore patients should be followed up more closely .