肾嫌色细胞癌107例临床病理特点及预后相关因素分析  

Chromophobe renal cell carcinoma： clinical and pathological characteristics and prognostic factors in 107 cases

作　　者：刘炀[1] 李振华[1] 殷磊[1] 刘涛[1] 于泓远[1] 荆宏伟[1] 孔垂泽[1] Liu Yang;Li Zhenhua;Yin Lei;Liu Tao;Yu Hongyuan;Jing Hongwei;Kong Chuize(Department of Urology, the First Affiliated Hospital of China Medical University, Shenyang 110001, China)

机构地区：[1]中国医科大学附属第一医院泌尿外科,沈阳110001

出　　处：《中华泌尿外科杂志》2018年第6期428-432,共5页Chinese Journal of Urology

摘　　要：目的分析肾嫌色细胞癌临床病理特点及预后相关因素。方法回顾性分析2010年1月至2017年12月我院病理诊断为肾嫌色细胞癌的107例患者的临床资料。男50例，女57例。年龄16-81岁，中位年龄53岁。肿瘤直径1.6-30.0 cm，中位值为5.0 cm。肿瘤位于右侧55例，左侧51例，双侧1例。107例均行CT检查，其中24例CT检查可见钙化，19例可见星芒状瘢痕。13例行增强MRI检查，肿瘤多呈T1WI中低信号，T2WI混杂或低信号，增强后强化较均匀，强化程度一般略低于肾实质。采用χ2检验对不同类型肾嫌色细胞癌的临床参数进行比较；采用Kaplan-Meier法进行生存分析，采用单因素和多因素Cox比例风险回归模型评估相关危险因素。结果106例手术治疗的患者中，开放手术55例，其中经腹手术21例，经腰手术32例；腔镜手术51例。根治性手术89例，保留肾单位手术17例。1例全身多发转移，应用索拉非尼治疗。107例术后病理分期：T1期74例（69.2%），T2期28例（26.2%），T3期3例（2.8%），T4期2例（1.9%）。Ⅰ型肾嫌色细胞癌102例（95.3%），Ⅱ型肾嫌色细胞癌5例（4.7%）。Ⅰ型和Ⅱ型肾嫌色细胞癌患者在性别、年龄、肿瘤侧别、首发症状及T分期方面，差异均无统计学意义（P〉0.05）。107例随访4-95个月，中位时间40个月，失访4例，死亡5例。5年总生存率（OS）为93.1%。Ⅰ型肾嫌色细胞癌OS（92.2 %，94/102）与Ⅱ型肾嫌色细胞癌OS（80%，4/5）的差异无统计学意义（P=0.577）。Cox单因素及多因素回归分析结果显示，不同T分期及是否存在转移是影响预后的独立因素（均P〈0.05）。结论肾嫌色细胞癌少见，确诊主要依靠病理诊断，手术是治疗此类疾病的主要方法。该病恶性程度低，进展缓慢，预后良好。ObjectiveTo analyze the clinicopathological features and prognostic factors of chromophobe renal cell carcinoma.MethodsThe clinical data of 107 patients with pathologically diagnosed chromophobe cell carcinoma in our hospital from January 2010 to December 2017 were retrospectively analyzed. There were 50 males and 57 females. The age was 16-81 years , with a median age of 53 years. The diameter of the tumor was 1.6-30.0 cm and the median value was 5.0cm. The tumor was located on the right side in 55 cases, on the left side in 51 cases, and bilateral in 1 case. The clinical parameters of different types of renal chromophobe cancer were compared by the Chi square test. The survival analysis was carried out by Kaplan-Meier, and the risk factors were evaluated by single factor and multiple factor Cox proportional risk regression model.ResultsOne hundred and six patients underwent operation, with 55 by open surgery, and 51 by endoscopic surgery, including 89 radical surgery and 17 nephron-sparing surgery. One patient was treated with Sorafenib. Pathological stage T1 stage was 74 cases （69.2%）, T2 stage 28 cases （26.2%）, T3 stage 3 cases （2.8%）, T4 stage 2 cases （1.9%）. There were 102 cases of type Ⅰ chromophobe cell carcinoma （95.3%）, and 5 cases of type Ⅱ chromophobe cell carcinoma （4.7%）. There was no significant difference in gender, age, tumor side, first symptom and T staging in patients with type Ⅰ and Ⅱ chromophobe cell carcinoma （P〉0.05）. One hundred and seven patients were followed up for 4-95 months, with the median time of 40 months. Four cases were missed and 5 cases died. The 5 year survival rate was 93.1%. Cox univariate and multivariate regression analysis showed that different T staging and metastasis were independent prognostic factors （all P〈0.05）.ConclusionsRenal chromophobe cell carcinoma is rare and its diagnosis mainly depends on pathology. Surgery is the main method for the treatment. The malignant grade is low, progress is slow, and the prognosis is g

关 键 词：癌 肾细胞 嫌色细胞 病理 预后 

分 类 号：R737.11[医药卫生—肿瘤]