肾癌双侧肾上腺转移5例报告  

Bilateral adrenal metastasis in renal cell carcinoma(a report of 5 cases)

作　　者：蔡昊旻[1] 陈勇辉[1] 孔文[1] 张进[1] 黄翼然[1] 

机构地区：[1]上海交通大学医学院附属仁济医院泌尿外科,上海200127

出　　处：《现代泌尿外科杂志》2014年第6期364-366,共3页Journal of Modern Urology

基　　金：上海市市级医院新兴前沿技术联合攻关项目(No.SHDC12010104)

摘　　要：目的总结分析肾癌对侧和双侧肾上腺转移的临床特点,探讨其诊断、治疗和预后。方法回顾性分析仁济医院2004年12月至2013年6月间5例双侧肾癌肾上腺转移患者的临床资料,5例患者中,男3例,女2例,平均69.2岁。肾癌根治术后迟发转移1例,为术后随访时影像学发现,再次行手术切除同侧肾上腺,术后病理证实为透明细胞癌转移;原发灶手术前发现肾上腺异常4例,术后均予免疫或分子靶向药物保守治疗。结果 5例患者发现转移后平均随访时间29.6个月,予IFN-α免疫治疗3例,2例死亡,1例病情稳定(SD);索拉非尼靶向治疗2例,目前均为SD。结论肾癌双侧肾上腺转移较为罕见,根据患者既往病史,结合影像学检查多数可明确诊断,考虑到对转移灶积极手术可能导致肾上腺皮质功能不全,多数患者应予免疫或靶向药物保守治疗。Objective To summarize the experience of diagnostic and treatment of bilateral adrenal metastasis in renal cell carcinoma.Methods Data of 5 cases of bilateral adrenal metastasis in renal cell carcinoma treated during Dec.2004 to Jun.2013 in our hospital were reviewed,including 3 males and 2 females.the mean age at diagnosis was 69.2.Delayed adrenal metastasis after radical nephrectomy occurred in 1 case,which underwent secondary surgical treatment,and was pathological confirmed.Bilateral adrenal abnormalities were detected in the first visits of the other 4 patients.All patients received immunotherapy or targeted therapy.Results With an average follow-up of 29.6 months,3 patients were treated with IFN-α,and 2 of them died,the other one was in stable condition; 2 patients were treated with sorafenib,both in stable condition.Conclusions Bilateral adrenal metastasis is rare in renal cell carcinoma.Most cases can be diagnosed by imaging technique.A radical surgical treatment for the bilateral adrenal metastasis isn＇t always recommended because it might result in adrenocortical insufficiency,and immunotherapy or targeted therapy should be proposed for most cases.

关 键 词：肾癌 肾上腺 转移 

分 类 号：R737.11[医药卫生—肿瘤]