摘要
目的分析不同分型乳头状肾细胞癌的特点、诊疗及预后，以期提高其诊治水平。方法回顾性分析2005年1月至2011年1月收治14例乳头状肾细胞癌患者的临床资料。男7例，女7例。年龄20～77岁。临床表现肉眼血尿3例，腰痛3例，腹部包块1例，无症状者7例。肿瘤最大径1．6～7．8cm，平均3．8cm。左肾5例，右肾9例。术前TNM分期：T1aN0M08例，T1bN0M02例，T1aN0M1、T2aN。M0T3aN0M0、T3aN1M0各1例。行根治性肾切除术6例，肾部分切除术8例。结果乳头状。肾细胞癌I型6例，细胞呈乳头状分布，嗜碱性，被覆单层柱状上皮细胞轴心，胞质少，嗜碱性，核级低。Ⅱ型8例，肿瘤细胞大，胞质丰富，嗜酸性，乳头表面被覆假复层柱状上皮细胞，核级高。组织学分级高分化2例，中分化12例。14例患者随访12～80个月。1例（I型）术后26个月出现双肺多发转移，给予IL一2治疗，34个月出现肝转移、骨转移，给予靶向治疗，病情稳定。1例（Ⅱ型）术后23个月出现颈部淋巴结转移伴胸、腹腔积液，且均找到癌细胞，口服舒尼替尼治疗，术后42个月死亡。其余患者均无瘤生存。结论乳头状肾细胞癌国内少见。手术是目前首选的治疗方式。早期局限性乳头状肾细胞癌术后预后较好。靶向治疗可能成为转移性乳头状肾细胞癌治疗的新方向。
Objective To study the characteristics of different papillary renal cell carcinoma （PRCC） subtypes and their prognosis after nephrectomy. Methods Clinical data of 14 PRCC patients （7 males, 7 females） with ages ranging from 20 -77 in our institute from 2005 to 2011 were retrospectively re- viewed. There were 5 tumors in the left kidney and 9 tumors in the right kidney. The average maximum tumor diameter was 3.8 （ 1.6 - 7.8 ） cm. Patients presented with gross hematuria （ n = 3 ） , flank pain （ n = 3） , palpable abdominal mass （n = 1 ） or asymptomatic （n =7）. The TNM stages were 8 T~ NoM0, 2 Tlb N0Mo , 1 TI^NoML , 1 T2NoM0 , 1 T3aNoM0 and 1 T3,N1M0. Six patients were treated with radical nephrecto- my, 8 cases were treated with partial nephrectomy. Results There were 6 type I and 8 type II PRCCs ca- ses. In pathology, type I PRCC showed papillae covered by small cells with scanty basophilic cytoplasm, and arranged in a single layer on the papillary basement membrane with low nuclear grade. Type II PRCC was composed of cells with higher nuclear grade, abundant eosinophilic cytoplasm, and pseudostratified nu- clei on papillary cores. There were 12 well-differentiated cases, 2 moderate-differentiated cases and no poor- ly differentiated case. Follow-up was carried out from 12 to 80 months. During the follow-up, 1 patient with type I PRCC developed multiple lung metastases 26 month after surgery and deteriorated into hepatic and bone metastases at 34 month after surgery. We offered the patient with targeted therapy and the patient was still alive. There was 1 type II PRCC patient died with multiple metastases at 42 month after surgery. Others were still alive without local recurrence and metastasis. Conclusions PRCC is not a common subtvoe of renal cell carcinoma in China. Earl）＇ stage PRCC patient wouht achieve good prognosis after treated with ne- phrectomy. Targeted therapy is a good treatmenl optinn for metastatic papillary renal cell carcinoma patients.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2013年第2期96-100,共5页
Chinese Journal of Urology
关键词
癌
乳头状
癌
肾细胞
病理状态
体征和症状
治疗学
预后
Carcinoma, papillary
Carcinoma, renal cell
Pathological conditions, signs andsymptoms
Therapeutics
Prognosis
