摘要
目的 探讨嫌色性肾细胞癌(chRCC)的临床特征、病理学特点、手术疗效及预后,提高对该病的诊治水平。方法 回:顾性分析中国科学技术大学附属第一医院2015年6月2023年3月收治的71例chRCC患者的临床及随访资料,总结临床经验。同时比较肾部分切除(PN)组与根治性肾切除(RN)组围手术期各项指标。结果71例chRCC患者PN 26例,RN 45例。肿瘤T分期T1a 24例,T1b 31例,T2a 12例,T2b 4例。CT主要表现为肾脏等密度或稍低密度实性占位,动脉期呈轻、中度强化,强化程度低于肾实质,呈缓慢升高状态,静脉期及延迟期强化程度缓慢减退。65例CD117染色61例阳性,1例弱阳性;69例CK7染色62例阳性,1例弱阳性;60例Vimentin染色54例阴性;44例胶体铁染色33例阳性,8例弱阳性;70例Ki-67均呈阳性,中位Ki-67值为4.5%。PN组与RN组的年龄、术前肌酐清除率(Ccr)、术中出血量、术后血红蛋白下降值、术后白蛋白下降值、引流管留置时间、术后住院时间差异无统计学意义(均P>0.05)。PN组术后Ccr显著优于RN组,且PN组肿瘤最大径、T分期均低于RN组(均P<0.05)。68例患者成功随访,至随访结束,均为无瘤存活状态。结论 chRCC是一种少见、恶性度低、侵袭性低的肾细胞癌亚型,预后良好。其具有独特的CT影像学表现,常规病理和免疫组化能够确诊。PN在肾功能保护方面优于RN,PN是治疗T1期chRCC安全有效的手术方式。
Objective To investigate the clinical features,pathological features,surgical efficacy and prognosis of chromophobe renal cell carcinoma(chRCC),and to improve the level of diagnosis and treatment of this disease.Methods Clinical and follow-up data of 71 patients with chRCC from the First Affiliated Hospital of University of Science and Technology of China from June 2015 to March 2023 were retrospectively analyzed.Clinical experience was summarized.Meanwhile,the perioperative indexes of the partial nephrectomy(PN)group and the radical nephrectomy(RN)group were compared.Results There were 26 cases of PN and 45 cases of RN in 71 patients with chRCC.There were 24 cases of Tla,31 cases of T1b,12 cases of T2a,and 4 cases of T2b.CT mainly showed isodense or slightly low-density solid space occupying in the kidney,light and moderate enhancement in the arterial phase,and the enhancement degree was lower than the renal parenchyma,showing a slowly increasing state,and the enhancement degree in the venous phase and the delayed phase slowly decreased.Among 65 cases,61 cases were positive for CD117 staining,and 1 case was weakly positive.Among 69 cases,62 cases were positive for CK7 staining,and 1 case was weakly positive.Vimentin staining was negative in 54 of 60 cases.Among 44 cases,33 were positive for colloidal iron staining and 8 were weakly positive.Seventy cases of Ki-67 were all positive,with a median Ki-67 value of 4.5%.There were no statistically significant differences in age,preoperative creatinine clearance(Ccr),intraoperative blood loss,postoperative hemoglobin decline,postoperative albumin decline,drainage indent time and postoperative hospital stay between PN and RN groups(all P>0.05).The postoperative Ccr in PN group was significantly better than that in RN group,and the maximum tumor diameter and T stage in PN group were lower than those in RN group(all P<0.05).Sixty-eight patients were followed up successfully,and all of them were tumor free until the end of follow-up.Conclusion chRCC is a rare,low malignant and low invasive subtype of renal cell carcinoma with good prognosis.It has unique CT imaging findings and can be confirmed by routine pathology and immunohistochemistry.PN is superior to RN in renal function protection,and PN is a safe and effective surgical method for treating chRCC at T1 stage.
作者
李玉
项平
孔令全
黄涛
LI Yu;XIANG Ping;KONG Lingquan;HUANG Tao(Department of Urology,the First Afiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital),Hefei,Anhui 230001,China)
出处
《中华全科医学》
2023年第9期1453-1456,1540,共5页
Chinese Journal of General Practice
基金
安徽省科研编制计划项目(2022AH051256)。
关键词
嫌色性肾细胞癌
诊断
治疗
预后
Chromophobe renal cell carcinoma
Diagnosis
Treatment
Prognosis
作者简介
通信作者:黄涛,E-mail:dramantony@126.com。
