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【摘要】目的:对比分析青年与老年肾癌患者的病理特点的异同。方法和材料:将我院2005-2009年期间收治的84例符合条件的肾癌病例,按照年龄分为小于等于40岁的青年组(36例)和大于40岁的中老年组(48例),对其病理类型做对比分析。结果:两组病例病理类型均以透明细胞癌为主,所占比例分别是72.22%(26/36)和85.42%(41/48),在青年组发现5例Xp11.2易位/TFE3基因融合相关性肾癌,为老年组所没有的类型。结论:两组的病理类型均以透明细胞癌为主,但在青年组有Xp11.2易位/TFE3基因融合相关性肾癌,这一新的肾癌类型为今后青少年肾癌的研究提供了方向。
【关键词】青年;中老年;肾癌;病理;分析比较
doi:10.3969/j.issn.1006-1959.2010.05.021 文章编号:1006-1959(2010)-05-1051-03
Pathologic Characteristics of Renal Cell Carcinoma in Young and Elder Patients WEI Ben-lin,GUAN Zhi-zhen
【Abstract】Objective:To compare and analyze the Pathological characteristics of renal cell carcinoma in young adults and elder patients.Methods:A retrospective review of 84 patients who were diagnosed with RCC from 2005 to 2009 was performed.They were divided into two groups:young(≤40 years,36cases)and elder(>40 years,48 cases).Their Pathological characteristics were analyzed.Results:Clear cell carcinoma was the main pathological type in both groups,and the rates were 72.22%(26/36,young adults)and 85.42%(41/48,elder).In the young patients groups there were five cases of renal cell carcinomas associated with Xp11.2 translocations/TFE3 gene fusions and there was no such cases in the elder group.Conclusions:The main pathological type in both groups was clear cell carcinoma. Renal cell carcinoma associated with Xp11.2 translocations /TFE3 gene fusions were specially found inyoung patients,and it"s an important subject for study.
【Key words】Young adult;Elder patients;Renal cell carcinoma;Pathology;Analysis
分析对比青年与中老年肾癌患者的病理特点,对以后的临床工作提供理论支持和研究方向。
1.材料和方法
观察对象为本院自2005年至2009年经手术治疗确诊的84例肾癌患者。
诊断标准为经手术后病理切片诊断为肾细胞癌(Renal Cell Carcinoma,RCC),其病理分类按照2004年WHO分类标准。纳入标准为经手术治疗,临床资料齐全,随访依从性高者。排除标准为临床诊断肾癌但未经手术后病理确诊、资料不全、出院后无法随访者。观察指标为患者的病理类型。
1.1 一般资料:按以上标准,共纳入本组患者84例,按照年龄分成小于40岁青年组和大于40岁的中老年组两组。其中青年组有36例,中老年组有48例。青年组男性22例,女性14例,年龄18-40岁,平均31.4岁,住院天数10-34天,平均16.1天。中老年组男性36例,女性12例,年龄41-79岁,平均57.93岁,住院天数6-71天,平均17.2天。
1.2 临床表现:青年组偶发癌19例,有症状癌17例。其中腰痛者12例,血尿者9例,腰腹部包块者2例,部分患者同时有两种症状。右肾肿瘤17例,左肾肿瘤19例,其中下极肿瘤12例,中极肿瘤14例,上极肿瘤10例。TNM分期T1期24例,T2期3例,T3期4例(N1有2例),T4期5例,远处转移者(M1)1例。中老年组偶发癌30例,有症状癌18例,其中腰痛者8例,血尿者9例,腰腹部包块者1例,发热者1例。右肾肿瘤23例,左肾肿瘤25例,其中下极肿瘤18例,中极肿瘤21例,上极肿瘤9例。术前临床TNM分期T1期30例(N2有1例),T2期5例,T3期6例,T4期7例(N1有1例,N2有1例,M1有1例)。
1.3 影像学检查:所有患者术前均行B超检查,大部分患者行CT平扫+增强扫描,少部分患者行MRI检查。其中B超检查青年组1例未发现肿瘤,1例诊断为错构瘤,其准确率为94.44%(34/36),中老年组2例未发现肿瘤,1例诊断为错构瘤,其准确率为93.75%(45/48)。青年组33例术前行CT检查,均发现病变,其中1例术前为单发肿瘤,术中发现为多发肿瘤,1例术前诊断为错构瘤,其准确率为96.97%(32/33),3例行MRI检查均发现肿瘤。中老年组40例术前行CT检查,均发现病变,其中1例诊断为炎性改变,准确率为97.50%(39/40),8例行MRI检查均发现肿瘤。青年组有3例行DSA检查,均有阳性发现,中老年组5例行DSA检查,均有阳性发现。部分患者还做了静脉肾盂造影(KUB+IVP)、肾图核素扫描(ECT)、尿脱细胞学检查。
1.4 治疗:所有患者均行全麻下开放性手术治疗,其中青年组有3例行保留肾单位的肾部分切除术(NSS),33例行根治性肾切除术(RN)。中老年组有3例行保留肾单位的肾部分切除术,45例行根治性肾切除术。根治性手术切除范围包括患侧肾脏、肾脂肪囊、肾周筋膜、肾门淋巴结,上极大肿瘤尚包括同侧肾上腺。保留肾单位的肾部分切除术采取肿瘤楔形切除或半肾切除术,肿瘤边缘保留2mm正常肾组织。术中不做快速冰冻病理。青年组术后15例患者接受了免疫治疗,中老年组术后有21例患者接受了免疫治疗,方案为重组α干扰素(甘乐能)900万国际单位,肌肉注射,每周3次,连续3个月为一个周期,每年一个周期,共进行3个周期。所有接受免疫治疗的患者均出现发热副作用,对症治疗后可缓解,无中断治疗者。两组各有一例术前有远处转移的患者术后行索拉非尼(多吉美)分子靶向治疗联合α干扰素免疫治疗,方案为索拉非尼0.4口服,每天两次,α干扰素300万国际单位肌肉注射,每周5次,长期应用。
1.5 病理:术后病理显示,青年组透明细胞癌26例,占该组比例72.22%(26/36),其他类型有肾乳头状细胞癌4例,占11.11%(4/36),肾嫌色细胞癌1例,占2.78%(1/36),Xp11.2易位/TFE3基因融合相关性肾癌5例,占%13.89(5/36)。中老年组透明细胞癌41例,占该组比例85.41%(41/48),其他类型有肾乳头状细胞癌6例,占12.50%(6/48),肾嫌色细胞癌1例,占2.08%(1/48),未分类肾细胞癌1例,占2.08%(1/48,注:按传统分型为肉瘤样癌)。
1.6 统计学方法:用SPSS11.0软件包进行处理,各组间数据比较用χ2检验,P0.05(υ=1,χ2=2.18,0.10
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