肾脏偶发癌临床分析(附116例报告)  

Clinical analysis of 116 cases of incidentally detected renal cell carcinoma

作　　者：燕翔[1] 丁强[1] 方祖军[1] 郑捷[1] 姚孟树[1] 张元芳[1] 

机构地区：[1]复旦大学附属华山医院泌尿外科,上海200040

出　　处：《中华泌尿外科杂志》2004年第1期5-7,共3页Chinese Journal of Urology

摘　　要：目的　探讨肾脏偶发癌的临床特征、预后因素及诊治措施。　方法　 1993年至 2 0 0 1年肾脏偶发癌 116例 ,男 81例 ,女 35例 ,平均发病年龄 (5 7.2± 15 .6 )岁 ;与同期收治症状癌 138例的发病、诊治及预后等临床资料进行对比分析。　结果　肾脏偶发癌占肾癌的 4 5 .7% (116 /2 5 4 ) ,近 5年占 4 7.5 % (84 /177)。健康体检发现者占偶发癌的 6 3.8% (74 /116 )。偶发癌性别、平均发病年龄、侧别、吸烟史与症状癌差异无显著性意义 (P >0 .0 5 )。偶发癌B超检出率 98.2 % (10 8/110 )。按Robson分期 ,偶发癌Ⅰ～Ⅱ期占 6 9.0 % ,高于症状癌的 4 9.3% ;Ⅲ～Ⅳ期占 31.0 % ,低于症状癌的 5 0 .7% ,两者差异有显著性意义 (P <0 .0 5 )。偶发癌手术切除率 92 .2 % (10 7/116 ) ,病理类型透明细胞癌占 84 .1% ,明显高于症状癌的 6 0 .9% (P <0 .0 5 )。偶发癌术后 3年、5年生存率分别为 86 .5 %和 81.3% ,明显高于症状癌的 70 .8%和 6 4 .2 % (P均 <0 .0 5 )。多因素分析显示预后主要与肿瘤分期相关 (RR =4 .95 ,P <0 .0 5 )。　结论　肾脏偶发癌占肾癌的比例较以前增加 ,适当条件下的健康体检有积极意义 ;肿瘤分期明显低于症状癌 ,3年和 5年生存率明显高于症状癌 ,其预后与肿瘤分期相关 ;Objective To investigate the clinical features, diagnosis, treatment and prognosis of incidentally detected renal cell carcinoma. Methods The clinical data of 116 cases of incidentally detected renal cell carcinoma (IRC) and those of 138 cases of clinical renal cell carcinoma (CRC) in our hospital from January 1993 to December 2001 were compared and analysed.All the cases were followed up for assess-ment of survival rates. Results The incidence of IRC in renal tumors was 45.7%(116/254),and this ratio increased to 47.5%(84/177) in recent 5 years.IRC cases detected in physical examination accounted for 63.8%(74/116).The IRC detection rate in physical examination was increasing in recent years.There was no significant difference of sex,mean age of incidence,smoking history between IRC and CRC groups( P > 0.05 ).The detection rate of IRC by B-ultrasound accounted for 98.2%(108/110).The rate of surgical excision in IRC was 92.2%(107/116).Stage Ⅰ to Ⅱ lesions were found in 69.0% of the patients with IRC and in 49.3% with CRC.Stage Ⅲ to Ⅳ lesions were found in 31.0% of the patients with IRC and in 50.7% with CRC.Patients were followed up postoperatively for a mean of (45±40) months.The 3- and 5-year cancer specific survival rates were significantly higher in IRC than those in CRC (86.5% and 81.3% vs 70.8 % and 64.2%, P <0.05). Multivariate analysis via Cox proportional hazards model showed that the prognosis was associated with the cancer stages( RR =4.95, P <0.05). Conclusions The prevalence of incidentally detected renal cell carcinoma has increased recently.Suitable physical examination is helpful for detection of the cancer.The stage of IRC is significantly lower than that of CRC,which leads to higher 3- and 5-year cancer specific survival rate.Radical nephrectomy is effective for the treatment of IRC.

关 键 词：肾脏偶发癌 临床特征 预后 肿瘤分期 病理特点 

分 类 号：R737.11[医药卫生—肿瘤]