肾集合管癌预后不良的综合分析  

Collecting duct carcinoma of the kidney:the analysis of its poor prognosis

作　　者：张沂南[1] 王国民[2] 金讯波[1] 刘宇军[2] 赵南[3] 付云峰 

机构地区：[1]山东大学附属省立医院泌尿微创中心,济南250021 [2]复旦大学附属中山医院泌尿外科,上海200032 [3]聊城市人民医院泌尿外科,山东聊城252000 [4]山东省五莲县中医院泌尿外科,山东五莲262300

出　　处：《首都医科大学学报》2013年第3期368-371,共4页Journal of Capital Medical University

摘　　要：目的综合分析肾集合管癌的预后及其预后不良的原因。方法回顾性分析4家医院1 013例肾癌中9例肾集合管癌患者的临床、病理资料、综合治疗情况及随访资料。结果 9例集合管癌患者,占同期肾癌的0.888%。其中男6例,女3例,平均年龄60.8岁(37～84岁)。因腰痛、血尿、腹部肿块就诊者6例,无症状肾癌3例。平均肿瘤体积为8.2 cm×6.7 cm×5.9 cm。肿瘤生长呈现肾内转移(5例)、血行转移(6例)、淋巴转移(5例)、直接浸润(2例)及远处转移(1例)等高度恶性生物学行为。临床分期中6例为IV期,I期仅有3例。5例行根治性肾切除术(1例为手助腹腔镜根治性肾切除术),4例行姑息性切除术(1例为手助腹腔镜姑息性肾切除术)。7例行辅助免疫治疗,2例行补救性化疗。平均随访时间13.7个月(7～22个月),6例死亡患者平均生存时间12.7个月。结论肾集合管癌预后不良,其高度恶性的生物学行为是肾集合管癌预后不良的基础原因;目前各医疗机构对肾集合管癌的认识程度差异有统计学意义,治疗方式缺乏特异性,是肾集合管癌预后不良的另一重要原因。随着病例的累积和对于肾集合管癌认知程度的提高,将更加准确的评估和理解肾集合管癌的预后。Objective To analyze the prognosis of collecting duct carcinoma （CDC） of the kidney, and the possible reasons that caused its poor prognosis. Methods Through a muhicenter retrospective study, the clinical, pathological, operational and adjuvant therapeutic data of 9 CDC cases out of 1 013 renal cell carcinoma （RCC） cases from 4 institutions were recorded and analyzed. Results Nine CDC cases, 0. 888% of the total RCC cases, were finally confirmed, in which there were 6 male and 3 female CDC patients with the mean age of 60. 8 （ range from 37 to 84） years old. Lumbodynia, hematuria, abdominal masses were observed in 6 cases. Three of 9 cases were in AJCC clinical stage Ⅰ, and the other 6 in stage Ⅳ, with the mean tumor volume of 8.2 cm× 6. 7 cm × 5.9 cm. Intrarenal metastasis （5 cases） , hematogenous metastasis （ 6 cases） , regional lymph nodes metastases （ 5 cases ） , local invasion （ 2 cases ） and liver metastasis （ 1 case） were histologically observed. Five cases underwent radical nephreetomy （ 1 case of hand-assistant laparoscopic radical nephrectomy） and 4 underwent palliative nephrectomy （1 case of hand-assistant laparoscopic palliative nephrectomy）. Seven cases underwent adjuvant immunotherapy, and 2 cases underwent salvage chemotherapy. The mean follow-up period was 13.7 months （ranged from 7 to 22 months） ; the mean survival time of 6 patients was 12. 7 months. Conclusion The prognosis of CDC was poor. The highly aggressive biological behavior is basically responsible for its prognosis. Due to lack of knowledge of the CDC, the treatment for CDC had no specificity. With the accumulation of the reported cases, the understanding of CDC＇s prognosis would be more objective.

关 键 词：肾肿瘤 肾癌 肾集合管癌 预后 

分 类 号：R737.11[医药卫生—肿瘤]