胰腺转移性肾透明细胞癌的临床病理特征和预后分析  

The clinicopathologic features and prognostic analysis of pancreatic metastasis from clear cell renal cell carcinoma

作　　者：张智旸[1] 李孝远[1] 白春梅[1] 周毅[2] 吴晰[3] 杨爱明[3] 花苏榕[4] Zhang Zhiyang;Li Xiaoyuan;Bai Chunmei;Zhou Yi;Wu Xi;Yang Aiming;Hua Surong(Department of Oncology,Peking Union Medical College Hospital,Chinese Academy of Medical Science,Peking Union Medical College,Beijing 100730,China;Department of Urology,Peking Union Medical College Hospital,Chinese Academy of Medical Science,Peking Union Medical College,Beijing 100730,China;Department of Gastroenterology,Peking Union Medical College Hospital,Chinese Academy of Medical Science,Peking Union Medical College,Beijing 100730,China;Department of General Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Science,Peking Union Medical College,Beijing 100730,China)

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肿瘤内科,100730 [2]中国医学科学院北京协和医学院北京协和医院泌尿外科,100730 [3]中国医学科学院北京协和医学院北京协和医院消化内科,100730 [4]中国医学科学院北京协和医学院北京协和医院基本外科,100730

出　　处：《中华肿瘤杂志》2020年第1期44-49,共6页Chinese Journal of Oncology

摘　　要：目的探讨胰腺转移性肾透明细胞癌患者的临床病理特征和预后。方法回顾性分析2000年1月至2018年12月在北京协和医院收治的经病理确诊的18例胰腺转移性肾透明细胞癌患者的临床病理资料。结果18例患者中,男11例,女7例;确诊肾透明细胞癌的平均年龄为51.4岁。其中左肾8例(44.4%),右肾10例(55.6%);同时性转移3例,异时性转移15例,从确诊肾透明细胞癌到发现胰腺转移的中位发生转移的时间为156个月,主要临床表现有腹痛、黄疸、消化道出血、恶心、乏力、体重下降等。其中胰腺单病灶患者7例(38.9%),多病灶患者11例(66.1%),9例患者(50.0%)除胰腺外还同时存在其他部位转移。5例患者行胰腺转移灶切除,15例患者服用靶向药物治疗。随访时间1~361.5个月,平均随访时间为171.7个月,死亡5例,生存13例,中位生存时间为122个月,5年生存率为81.4%。是否为同时性转移、是否为10年后复发、纪念斯隆-凯特琳癌症中心模型预后评分以及国际转移性肾细胞癌联合数据库评分是影响胰腺转移性肾透明细胞癌患者预后的因素。结论胰腺转移性肾透明细胞癌罕见,但预后较好,尤其是10年后复发转移至胰腺的患者,行手术切除胰腺转移灶未发现明显的生存获益。Objective To investigate the clinicopathologic features and prognosis of the patients who had clear cell renal cell carcinoma(CCRCC)with metastasis to the pancreas.Methods From Jan,2000 to Dec,2018,18 patients with clear cell renal cell carcinoma(CCRCC)and had pathologically diagnosed metastasis to the pancreas were enrolled at Peking Union Medical College Hospital.The clinical and pathological data were retrospectively analyzed.Results 11 out of 18 patients were male,and the other 7 were female.The average age of onset of CCRCC was 51.4 years.8 cases(44.4%)occurred in the left kidney,and the other 10 cases(55.6%)with right kidney tumor.Three patients had synchronous pancreatic metastasis,and the other 15 patients had metachronous pancreatic metastasis.The median time from CCRCC onset to pancreas metastasis was 156 months.The main complaints of pancreas metastasis were abdominal pain,jaundice,gastrointestinal bleeding,nausea,weakness,loss of weight and so on.Seven patients(38.9%)had single lesion of pancreas,while 11 patients(66.1%)had multiple lesions of pancreas.Nine patients(50%)had other organs metastasis besides pancreatic metastasis at the same time.Five patients underwent pancreatic metastasis resection,while 15 patients received oral tyrosine kinase inhibitor(TKI).The mean follow-up was 171.7 months(1~361.5 months)and 5 patients died.The median overall survival(mOS)was 122 months,and the 5 year-survival rate was 81.4%.In univariate analysis,synchronous metastasis to the pancreas,relapse after 10 years,Memorial Sloan Kettering Cancer Center prognostic index,International Metastatic Renal Cell Carcinoma Database Consortium index were all significant parameters for patients′survival.Conclusions Metastasis to the pancreas from clear cell renal cell carcinoma were rare.These patients had better survival outcomes,especially those relapsing after ten years.Pancreatic metastasis resection had no significant benefit on patient′s survival.

关 键 词：肾透明细胞癌 肿瘤转移 胰腺 生存 酪氨酸酶抑制剂 

分 类 号：R737[医药卫生—肿瘤]