| 摘要: |
| 目的 收集、随访并分析16例肾癌伴肉瘤样分化患者临床资料并行文献复习,探讨肾癌伴肉瘤样分化患者临床治疗方法及预后。方法 2005年至2009年我院泌尿外科行肾癌手术的患者共547例,其中伴肉瘤样分化的肾癌16例(2.9%)。男性7例,女性9例；年龄52±10(36~70) 岁；临床表现为肉眼血尿者5例,腰酸痛5例,乏力、消瘦2例,咳嗽、咯血1例,体检发现肾脏占位者3例；肿瘤均为单发,其中左侧7例、右侧9例；肿瘤最大径7.8±4.1 (2~15) cm。术前充分检查以明确肿瘤分期。术前检查提示腹膜后淋巴结肿大2例,右肺门淋巴结肿大1例,肝转移1例,肾静脉和(或)下腔静脉癌栓2例,骨转移3例,侵犯同侧肾上腺1例,侵犯输尿管上段1例。16例患者均行手术治疗,病理标本常规行H-E染色及免疫组化检查。术后5例患者行INF-α治疗并进行随访。结果 所有患者行肾癌根治术,病理结果显示肾透明细胞癌伴肉瘤样分化9例,肾嫌色细胞癌伴肉瘤样分化3例,未分类肾细胞癌伴肉瘤样分化4例。术后分期与术前分期相同。4例pT1N0M0患者随访至今无复发或转移,pT2~T4患者已全部死亡,其无进展生存期为5.6±4.5(2~16)个月,总生存期为8.3±5.6(3~20)个月。结论 肾癌伴肉瘤样分化患者术前分期对患者预后影响较大,早期患者行手术治疗是最有效的治疗方法,建议早期患者术后定期复查以监视肿瘤复发、转移等情况,对于晚期患者靶向治疗可能有效。 |
| 关键词: 肾肿瘤 肾细胞癌；肉瘤样分化；治疗 |
| DOI：10.3724/SP.J.1008.2011.01016 |
| 投稿时间：2011-07-02修订日期：2011-08-04 |
| 基金项目:上海市市级医院新兴前沿技术联合攻关项目(SHDC12010115), 上海市重点学科项目. |
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| Renal cell carcinoma complicated with sarcomatoid differentiation: treatment, prognosis and literature review |
| SHENG Hai-bo△,WANG Lin-hui△,YANG Qing,LIU Bing,WU Zhen-jie,CHEN Wei,XU Zun-li,SUN Ying-hao* |
(Department of Urology, Changhai Hospital Level, Second Military Medical University, Shanghai 200433, China
△Co-first authors.
*Corresponding author.) |
| Abstract: |
| ObjectiveTo retrospectively analyze the clinical data of 16 patients with renal cell carcinoma complicated with sarcomatoid differentiation, so as to discuss the treatment and prognosis of the condition. MethodsA total of 547 patients with renal cell carcinoma were admitted in our department during 2005-2009, and 16(2.9%) of them also had sarcomatoid differentiation, including 7 males and 9 females, aged (52 ± 10) years old, ranging 36-70 years old. Gross hematuria was found in 5 patients, backache in 5, fatigue and weight loss in 2, cough and hemoptysis in 1; and 3 patients were accidentally found with renal occupation during physical examination. All tumors were solitary, with 7 in the left and 9 in right. The maximum tumor diameter was (7.8±4.1) cm, ranging 2-15 cm. Full examination was done to confirm the tumor stage preoperatively. Preoperative examination showed that 2 patients had retroperitoneal lymph node enlargement,1 had right pulmonary hila lymphatic metastasis, 1 had liver metastasis, 2 had renal vein and (or) the inferior vena cava tumor thrombi, 3 had bone metastases, 1 had invasion of ipsilateral adrenal gland, and 1 had invasion of the upper ureter. All the 16 patients underwent surgical treatment,and their specimens were subjected to H-E staining and immunohistochemical examination. Five patients were treated with INF-α after operation and were followed up. ResultsAll patients received radical nephrectomy. Pathological examination showed that 9 patients had clear cell renal cell carcinoma with sarcomatoid differentiation, 3 had chromophobe renal cell carcinoma with sarcomatoid differentiation, and the other 4 had unclassified renal cell carcinoma with sarcomatoid differentiation. No recurrence or metastasis was seen in the 4 pT1N0M0 patients. All the pT2-T4 patients died, with the progression-free survival time being (5.6±4.5) months, ranging 2-16 months; the overall survival time was (8.3±5.6) months, ranging 3-20 months. ConclusionPreoperation staging of patients with renal cell carcinoma complicated with sarcomatoid differentiation has a great impact on patient survival. Operation is the most effective treatment for patients with early stage, and routine follow-up examination is recommended postoperatively.Targeted therapy may be an effective way for patients of advanced stage. |
| Key words: kidney neoplasms renal cell carcinoma sarcomatoid differentiation therapy |
