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| 肾细胞癌骨转移病理特点分析与配对研究 |
| 董毅1△,王辉1△,王良哲2,琚官群1,鲍一1,王正1,吴震杰1,刘冰1,徐红1,王林辉1* |
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(1. 海军军医大学(第二军医大学)长征医院泌尿外科, 上海 200003;
2. 海军军医大学(第二军医大学)长征医院病理科, 上海 200003
△共同第一作者
*通信作者) |
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| 摘要: |
| 目的 分析肾细胞癌骨转移组织病理及免疫组织化学特点，探讨肾细胞癌骨转移的病理学相关特点与转移高危因素。方法 回顾性分析海军军医大学（第二军医大学）长征医院2012年1月至2017年12月收治的经病理确诊的1 694例肾细胞癌患者（未发生骨转移）与133例肾细胞癌骨转移患者的病理学特征与免疫组织化学特点，并对25例先后或同时于长征医院切除肾癌原发灶和骨转移灶的肾细胞癌患者的病理资料进行配对分析。结果 未发生骨转移肾细胞癌患者中男性所占比例（70.1%，1 188/1 694）低于骨转移肾细胞癌患者（84.2%，112/133），肾透明细胞癌所占比例（83.4%，1 412/1 694）低于骨转移肾细胞癌患者（93.6%，103/110），差异均有统计学意义（P均<0.01）。在未发生骨转移肾透明细胞癌患者和骨转移肾透明细胞癌患者中，Fuhrman核分级Ⅲ/Ⅳ级者分别占17.7%（247/1 398）和51.6%（32/62），差异有统计学意义（P<0.001）。在配对分析的25例骨转移肾细胞癌患者中，11例（44.0%）组织病理学提示肿瘤侵犯或突破肾包膜，同期未发生骨转移肾细胞癌患者中18.9%（320/1 694）病理检查提示侵犯或突破肾包膜，发生骨转移的肾细胞癌患者侵犯或突破肾包膜的比例高于同期未发生骨转移的肾细胞癌患者（P=0.002）。配对分析显示肾脏原发灶中Ki-67标记指数低于骨转移灶[中位数（下四分位数，上四分位数）：5.0%（2.0%，6.0%）vs 6.0%（3.0%，15.0%），P<0.001]。结论 肾透明细胞癌较肾非透明细胞癌更容易发生骨转移，男性、Fuhrman核分级Ⅲ/Ⅳ级和侵犯肾被膜是发生骨转移的高危因素。骨转移灶Ki-67标记指数较原发灶高，提示原发灶与转移灶的病理特点并不完全相同，获取骨转移组织进行病理分析或可指导治疗。 |
| 关键词: 肾肿瘤 肾细胞癌 骨转移 病理学 免疫组织化学 配对分析 |
| DOI：10.16781/j.0258-879x.2019.04.0394 |
| 投稿时间：2018-08-14修订日期：2019-02-22 |
| 基金项目:国家自然科学基金重点项目（81730073），军队医学科研计划青年培训项目（15QNP057）. |
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| Pathological analysis of renal cell carcinoma bone metastasis and matched-pair study |
| DONG Yi1△,WANG Hui1△,WANG Liang-zhe2,JU Guan-qun1,BAO Yi1,WANG Zheng1,WU Zhen-jie1,LIU Bing1,XU Hong1,WANG Lin-hui1* |
(1. Department of Urology, Changzheng Hospital, Naval Medical University(Second Military Medical University), Shanghai 200003, China;
2. Department of Pathology, Changzheng Hospital, Naval Medical University(Second Military Medical University), Shanghai 200003, China
△Co-first authors.
* Corresponding author) |
| Abstract: |
| Objective To analyze the clinicopathological and immunohistochemical characteristics of renal cell carcinoma (RCC) bone metastasis, and to explore the pathological characteristics and high-risk factors of bone metastasis in RCC patients. Methods A retrospective study was conducted on the clinicopathological and immunohistochemical characteristics of 1 694 RCC patients without bone metastasis and 133 RCC patients with bone metastasis, who were admitted to Changzheng Hospital of Naval Medical University (Second Military Medical University) from Jan. 2012 to Dec. 2017. The paired pathological data of primary and bone metastatic lesions were analyzed in 25 RCC patients whose primary and bone metastatic lesions were removed successively or simultaneously in Changzheng Hospital. Results Compared with the RCC patients with bone metastasis, the proportion of males was significantly lower in the RCC patients without bone metastasis (70.1%[1 188/1 694] vs 84.2%[112/133], P<0.01), and the proportion of clear cell RCC (CCRCC) patients was also significantly lower (83.4%[1 412/1 694] vs 93.6%[103/110], P=0.004). Fuhrman nuclear grade Ⅲ/Ⅳ accounted for 17.7% (247/1 398) and 51.6% (32/62) in the CCRCC patients without bone metastasis and with bone metastasis, respectively, and the difference was significant (P<0.001). The proportion of the patients having tumor invasion or breakthrough of the renal capsule was 44.0% (11/25) in the 25 patients with bone metastasis having matched data and 18.9% (320/1 694) in the RCC patients without bone metastasis, and the difference was significant (P=0.002). Matching analysis showed that the Ki-67 marker index was significantly lower in the primary lesions than that in the bone metastatic lesions (median[lower quartile, upper quartile]:5.0%[2.0%, 6.0%] vs 6.0%[3.0%, 15.0%], P<0.001). Conclusion CCRCC is more prone to bone metastasis than non-CCRCC. Male, Fuhrman grade Ⅲ/Ⅳ and invasion of renal capsule are high risk factors of bone metastasis. The Ki-67 marker index is higher in bone metastatic lesions than that in primary tumor, suggesting that the pathological characteristics of primary and bone metastatic lesions are not identical and the pathological analysis may guide treatment. |
| Key words: kidney neoplasms renal cell carcinoma bone metastasis pathology immunohistochemistry matched-pair analysis |
