肾癌根治术后围手术区域复发转移28例报告  

Recurrence and metastasis of perioperative areas of renal cell carcinoma after radical nephrectomy:a report of 28 cases

作　　者：郑克文[1] 李汉忠[1] 张玉石[1] 李永强[1] 邓建华[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院泌尿外科,北京100730

出　　处：《现代泌尿外科杂志》2015年第2期96-99,共4页Journal of Modern Urology

摘　　要：目的分析肾癌根治术后围手术区域（同侧肾上腺、肾窝、局部淋巴结和腹壁）肿瘤复发转移的临床特点,探讨处理原则。方法收集2010年1月至2014年8月北京协和医院收治的28例肾癌根治术后围手术区域肿瘤复发转移患者。男性13例,女性15例,年龄24-82岁,中位年龄49岁。透明细胞癌19例,乳头状细胞癌6例（其中II型乳头状癌4例）,嫌色细胞癌1例,多房囊性肾细胞癌2例。病理分级FurmanⅠ级8例,FurmanⅡ-Ⅲ级20例。开放手术18例,腹腔镜手术10例。原发肾脏肿瘤中T1a期1例,T1b期10例,T2期10例,T3期4例,T4期3例。原发肿瘤直径3-16cm。结果本组围手术区域复发转移部位分别为,肾窝19例,局部淋巴结7例,同侧肾上腺6例,腹壁7例。所有患者均行分子靶向药物治疗。5例行挽救性手术或减瘤手术,1例放疗,1例射频消融治疗。随访时间为6-53个月,无进展生存期2-18个月,中位无进展生存期10个月,死亡8例,12例疾病稳定,1年生存率为88.9%,2年生存率为77.8%。结论围手术区域肿瘤复发转移的肾癌患者原发肿瘤普遍体积偏大、分期偏晚,病理类型以透明细胞癌为主,其次为Ⅱ型乳头状肾细胞癌,病理级别普遍较高。处理上,通常再次手术难度大、风险较高,且肿瘤不易切除干净,推荐结合分子靶向药物治疗的综合治疗方案。Objective To analyze the clinical characteristics of recurrence and metastasis of perioperative areas（including homolateral adrenal gland,renal fossa,regional lymph nodes,and abdominal wall）of renal cell carcinoma after radical nephrectomy,and to explore the management.Methods Clinical data of 28 cases of renal cell carcinoma treated in Peking Union Medical College Hospital during Jan.2010 to Aug.2014 were retrospective analyzed.The patients included 13 male and15 female,aged 24-82 years,median 49 years.There were 19 clear cell carcinoma,6 papillary carcinoma（4 cases of typeⅡ）,1 chromophobe carcinoma,and 2 multiple cystic renal cell carcinoma.Pathological grading showed 8 cases of Furman I and20 cases of FurmanⅡ-Ⅲ.Of all cases,18 underwent open radical nephrectomy and10 laparoscopic radical nephrectomy.The pathological stage included 1 case of T1 a,10 cases of T1 b,10 cases of T2,4 cases of T3,and 3 cases of T4.The size of primary tumor was 3-16 cm.Results Up to19 cases had recurrence or metastasis in renal fossa,7in regional lymph nodes,6in homolateral adrenal gland,and7 in the abdominal wall.All patients underwent targeted therapy,5 received salvage or cytoreductive surgery,1 radiotherapy,and 1 radiofrequency ablation.During the follow-up of 6-53 months,8 patients died.The progression free survival（PFS）was 2-18 months,and the median PFS was 10 months.The one-year and two-year survival-rate was 88.9% and77.8%respectively.Conclusions Cases with perioperative regional tumor recurrence or metastasis after radical nephrectomy tend to be in large size and late stage.Clear cell carcinoma is the major pathologic type,followed by type II papillary renal cell carcinoma.Since salvage tumor excision is difficult and risky,we recommend comprehensive treatment including targeted therapy.

关 键 词：肾癌 围手术区域 复发 转移 靶向药物 

分 类 号：R737.11[医药卫生—肿瘤]