摘要
目的 结合病例及文献就小肾癌同期发生远处转移相关因素、常见转移部位及诊断治疗策略做一介绍,提高对小肾癌同期发生远处转移的认识.方法 回顾性分析西安交通大学第一附属医院泌尿外科肾癌患者临床资料,共发现4例小肾癌同期转移：患者均为男性,年龄40～68岁.影像学检查提示肾肿瘤直径均小于4 cm,肺部、对侧肾上腺及全身多处骨骼发现转移病灶.所有患者临床诊断均为T1aN0M1.结果 4例患者分别行肾部分切除术、肾切除术、肋骨转移灶切除术、肾上腺转移瘤切除术及肾动脉栓塞术,术后给予分子靶向及细胞因子治疗;术后病理结果为透明细胞癌Ⅱ～Ⅲ级;术后随访：1例患者良好,未发现局部进展及转移病灶,1例失访,2例患者死亡,其中1例病情进展,死于多器官功能衰竭,另1例死亡原因不明.结论 小肾癌同期远处转移并不罕见,特别是病理诊断为高度恶性,微血管侵犯及病理类型为肉瘤样、乳头状和嫌色细胞癌的患者.小肾癌同期发生远处转移者治疗效果远较无同期转移者差,预后主要取决远处转移部位、病理分级和病理类型.
Objective To review factors associated with metastasis,common metastatic sites,strategies for diagnosis and treatment of the metastatic small renal cell carcinoma.Methods Data of 4 patients with metastatic small renal cell carcinoma treated in our hospital were retrospectively studied.All patients were male,aged between 40-68 years.The tumor diameter was less than 4 cm and the distant metastatic sites were the multiple bone,lung and solitary contralateral adrenal metastasis,respectively.All patients were clinically diagnosed as T1a N0M1.Results All patients underwent nephron sparing partial nephrectomy,nephrectomy,rib resection of metastatic lesions,adrenal metastases resection,renal artery embolization and received molecular targeted therapy and cytokines therapy after operation,respectively.The pathological results showed clearcell carcinoma （Robson Ⅱ-Ⅲ）.During the follow-up,2 patients died,one for one multiple organ failure,and another for unknown causes.Conclusions Metastasis of small renal cell carcinoma is not uncommon,especially among patients with highgrade,microvascular invasion and pathological sarcomatoid,papillary and chromophobe renal cell carcinoma.Prognosis of small renal cell carcinoma with distant metastasis was poor than those without metastasis,mainly depending on the distant metastatic sites,pathological grading and types.
出处
《现代泌尿外科杂志》
CAS
2014年第6期374-377,共4页
Journal of Modern Urology
关键词
小肾癌
同期转移
手术
免疫治疗
small renal cell carcinoma
synchronous metastatic
operation
immunotherapy
