单中心肾细胞癌患者临床病理特征、手术情况及10年变化趋势分析
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摘要
目的:分析肾细胞癌患者临床病理特征、手术方式及近10年来变化趋势。方法:回顾性分析2008年1月～2017年12月我院1 498例行手术治疗的肾细胞癌患者的临床资料。结果:1 498例肾癌患者中,男1017例,女481例;平均年龄(55.9±11.73)岁;透明细胞癌1 278例,乳头状肾细胞癌84例,其他类型肾癌共计136例;病理检查发现有坏死117例,肉瘤样变36例,肉瘤样变肾癌患者中位生存时间为14个月,1年生存率63.0%;发现术前发生转移83例,发生静脉瘤栓47例;临床分期Ⅰ期1 257例,Ⅱ期及以上241例;行根治性肾切除术962例,行保留肾单位手术536例。结论:肾癌患者存在城乡分布差异,城镇患者比例高于农村患者;男性患者较女性可能有更高的病理级别。肉瘤样肾癌患者总生存时间及1年生存率明显低于肾癌患者整体水平;肾部分切除术能更好的保护肾功能,腹腔镜手术具有出血少、住院时间短的微创优势,机器人辅助腹腔镜手术与腹腔镜手术在术中出血、住院天数及术后肌酐方面未见明显差异,但手术时间长于腹腔镜手术。近10年来,肾癌患者年龄、性别、病理类型、病理分级各构成比未见明显变化,无症状患者比例逐年降低,行肾部分切除术及腹腔镜、机器人辅助腹腔镜微创手术比例逐年提高。
Objective:To analyze the clinicopathological features,surgical methods and trends of renal cell carcinoma patients in the past 10 years.Method:The clinical data of 1 498 surgically treated patients with renal cell carcinoma from Xijing Hospital from January 2008 to December 2017 were collected and retrospectively analyzed.Result:Among the 1 498 patients with renal cell carcinoma,1 017 were male and 481 were female.The average age was(55.9±11.73)years old;1 278 cases of clear cell carcinoma,84 cases of papillary cell carcinoma,136 cases of other types of renal cell carcinoma.Pathological examination revealed 117 cases of necrosis and 36 cases of sarcomatoid degeneration,the median survival time of patients with sarcomatoid renal cell carcinoma was 14 months,and 1-year survival rate was 63.0%.Eighty-three cases were found to have metastasis before operation,47 cases have venous tumor thrombus;1 257 cases were clinical stageⅠ,241 cases were clinical stageⅡand above.Radical nephrectomy was performed in 962 cases,and 536 cases received partial nephrectomy.Conclusion:There is difference between urban and rural distribution of patients with renal cell carcinoma,and the proportion of urban patients is higher than that of rural patients.Male patients may have higher pathological grades than females.The overall survival time and 1-year survival rate of patients with sarcomatoid renal cell carcinoma were significantly lower than those of all patients with renal cell carcinoma.Partial nephrectomy can protect kidney function better than nephrectomy.Laparoscopic surgery has minimally invasive advantages of less blood loss and shorter hospital stay.Robot-assisted laparoscopic surgery and laparoscopic surgery show no significant difference in intraoperative blood loss,hospitalization days or postoperative creatinine,but the operation time of robot-assisted laparoscopic surgery is longer than that of laparoscopic surgery.In the past 10 years,the age,sex,pathological type,and pathological grade of renal cancer patients have not changed significantly.The proportion of asymptomatic patients has decreased year by year.The proportion of partial nephrectomy and invasive surgery including laparoscopy and robot-assisted laparoscopic surgery has increased year by year.
Objective:To analyze the clinicopathological features,surgical methods and trends of renal cell carcinoma patients in the past 10 years.Method:The clinical data of 1 498 surgically treated patients with renal cell carcinoma from Xijing Hospital from January 2008 to December 2017 were collected and retrospectively analyzed.Result:Among the 1 498 patients with renal cell carcinoma,1 017 were male and 481 were female.The average age was(55.9±11.73)years old;1 278 cases of clear cell carcinoma,84 cases of papillary cell carcinoma,136 cases of other types of renal cell carcinoma.Pathological examination revealed 117 cases of necrosis and 36 cases of sarcomatoid degeneration,the median survival time of patients with sarcomatoid renal cell carcinoma was 14 months,and 1-year survival rate was 63.0%.Eighty-three cases were found to have metastasis before operation,47 cases have venous tumor thrombus;1 257 cases were clinical stageⅠ,241 cases were clinical stageⅡand above.Radical nephrectomy was performed in 962 cases,and 536 cases received partial nephrectomy.Conclusion:There is difference between urban and rural distribution of patients with renal cell carcinoma,and the proportion of urban patients is higher than that of rural patients.Male patients may have higher pathological grades than females.The overall survival time and 1-year survival rate of patients with sarcomatoid renal cell carcinoma were significantly lower than those of all patients with renal cell carcinoma.Partial nephrectomy can protect kidney function better than nephrectomy.Laparoscopic surgery has minimally invasive advantages of less blood loss and shorter hospital stay.Robot-assisted laparoscopic surgery and laparoscopic surgery show no significant difference in intraoperative blood loss,hospitalization days or postoperative creatinine,but the operation time of robot-assisted laparoscopic surgery is longer than that of laparoscopic surgery.In the past 10 years,the age,sex,pathological type,and pathological grade of renal cancer patients have not changed significantly.The proportion of asymptomatic patients has decreased year by year.The proportion of partial nephrectomy and invasive surgery including laparoscopy and robot-assisted laparoscopic surgery has increased year by year.
引文
1赵振威,李延江.肾细胞癌流行病学的研究进展[J].山东医药,2013,53(7):95-97.
2刘浩然,叶章群.肾癌基础研究新进展[J].现代泌尿生殖肿瘤杂志,2017,9(5):257-261.
3李汉忠,王子明,李黎明,等.中国多中心五年肾癌诊治现状分析[C].全国泌尿外科学术会议,2013.
4王浩,史佳,王爱香,等.1 734例肾细胞癌临床病理特点分析[J].北京医学,2014,36(2):111-113.
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6李鸣,何志嵩,高江平,等.多中心肾癌临床特征分析[J].中华泌尿外科杂志,2010,31(2):77-80.
7甘卫东,曹翔,郭宏骞.MiTF家族相关性肾癌的研究进展[J].中华腔镜泌尿外科杂志(电子版),2014,8(6):1-4.
8唐双阳,毕兴,李东亮,等.334例肾细胞癌患者的预后因素分析[J].肿瘤杂志,2015,35(7):782-787.
9 Lebacle C,Pooli A,Bessede T,et al.Epidemiology,biology and treatment of sarcomatoid RCC:current state of the art[J].World J Urol,2018:1-9.
10 Streja E,Kalantar-Zadeh K,Molnar M Z,et al.Radical versus partial nephrectomy,chronic kidney disease progression and mortality in US veterans[J].Nephrol Dial Transplant,2018,33(1):95-101.
11李晓红.腹腔镜保留肾单位肾肿瘤切除术与根治性肾切除术对肾细胞癌患者术后肾功能及生存质量影响分析[J].临床误诊误治,2017,30(2):95-98.
12曾晓明,雷弋,张天德,等.68例后腹腔镜肾部分切除术治疗肾脏肿瘤的临床疗效分析[J].临床泌尿外科杂志,2016,31(5):431-433.
13王锦涛,张秀利,陈文峰,等.腹腔镜与开放性肾部分切除术治疗恶性肾脏肿瘤的效果及对肾功能的影响[J].实用癌症杂志,2017,32(3):455-457.
14许晖阳,莫承强,王宗任,等.机器人辅助腹腔镜下肾部分切除术的短期疗效分析(附22例报告)[J].临床泌尿外科杂志,2017,32(5):335-338.
2刘浩然,叶章群.肾癌基础研究新进展[J].现代泌尿生殖肿瘤杂志,2017,9(5):257-261.
3李汉忠,王子明,李黎明,等.中国多中心五年肾癌诊治现状分析[C].全国泌尿外科学术会议,2013.
4王浩,史佳,王爱香,等.1 734例肾细胞癌临床病理特点分析[J].北京医学,2014,36(2):111-113.
5李亚健.全国多中心肾癌诊治资料分析及北京协和医院肾癌数据库的建立[C].北京协和医学院,2013.
6李鸣,何志嵩,高江平,等.多中心肾癌临床特征分析[J].中华泌尿外科杂志,2010,31(2):77-80.
7甘卫东,曹翔,郭宏骞.MiTF家族相关性肾癌的研究进展[J].中华腔镜泌尿外科杂志(电子版),2014,8(6):1-4.
8唐双阳,毕兴,李东亮,等.334例肾细胞癌患者的预后因素分析[J].肿瘤杂志,2015,35(7):782-787.
9 Lebacle C,Pooli A,Bessede T,et al.Epidemiology,biology and treatment of sarcomatoid RCC:current state of the art[J].World J Urol,2018:1-9.
10 Streja E,Kalantar-Zadeh K,Molnar M Z,et al.Radical versus partial nephrectomy,chronic kidney disease progression and mortality in US veterans[J].Nephrol Dial Transplant,2018,33(1):95-101.
11李晓红.腹腔镜保留肾单位肾肿瘤切除术与根治性肾切除术对肾细胞癌患者术后肾功能及生存质量影响分析[J].临床误诊误治,2017,30(2):95-98.
12曾晓明,雷弋,张天德,等.68例后腹腔镜肾部分切除术治疗肾脏肿瘤的临床疗效分析[J].临床泌尿外科杂志,2016,31(5):431-433.
13王锦涛,张秀利,陈文峰,等.腹腔镜与开放性肾部分切除术治疗恶性肾脏肿瘤的效果及对肾功能的影响[J].实用癌症杂志,2017,32(3):455-457.
14许晖阳,莫承强,王宗任,等.机器人辅助腹腔镜下肾部分切除术的短期疗效分析(附22例报告)[J].临床泌尿外科杂志,2017,32(5):335-338.