小肾癌伴远处转移8例报告并文献复习
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摘要
目的分析8例小肾癌伴远处转移患者的诊断及治疗情况,为临床少见病例的治疗提供借鉴和指导。方法回顾性分析我院8例小肾癌伴远处转移患者的临床资料及诊治经过,查阅相关文献并进行分析讨论。结果结合病史、查体及辅助检查结果,术前所有患者均考虑小肾癌伴远处转移,并行腹腔镜下肾部分切除术、转移灶切除术,术后给予分子靶向治疗,术后病理结果6例为透明细胞癌Ⅰ～Ⅲ级,2例为嫌色细胞癌;术后随访:7例患者良好,未发现局部及转移病灶进展,1例可见转移灶进展。结论小肾癌伴远处转移属于少见病例,特别是病理类型为肉瘤样、乳头状和嫌色细胞癌以及微血管侵犯的高度恶性肿瘤的患者。同期发生远处转移者治疗效果及预后远较无转移者差,腹腔镜早期手术及术后辅助靶向药物治疗可明显改善疾病预后及患者生活质量。
Objective To explore the diagnosis and treatment of small renal cell carcinoma with distant metastasis in order to improve its diagnosis and treatment.Methods The clinical data,diagnosis and treatment of 8 cases of small renal cell carcinoma with distant metastasis were analyzed and relevant literature was reviewed.Results Based on medical history,physical examination and auxiliary examination results,all cases were clinically diagnosed as small renal cell carcinoma with distant metastasis.All patients underwent laparoscopic partial nephrectomy and metastasectomy,and received molecular targeted therapy after operation.The pathological results confirmed clear cell carcinoma in 6 patients and chromophobe renal carcinoma in 2 cases.During the follow-up,metastasis progression was observed in 1 patient.Conclusion Small renal cell carcinoma with distant metastasis is uncommon,especially for patients with high-grade microvascular invasion and pathological sarcomatoid,papillary and chromophobe renal cell carcinoma.Patients with distant metastasis had poorer prognosis than those without metastasis.Early laparoscopic surgery and postoperative molecular targeted therapy can significantly improve the prognosis and patients' quality of life.
Objective To explore the diagnosis and treatment of small renal cell carcinoma with distant metastasis in order to improve its diagnosis and treatment.Methods The clinical data,diagnosis and treatment of 8 cases of small renal cell carcinoma with distant metastasis were analyzed and relevant literature was reviewed.Results Based on medical history,physical examination and auxiliary examination results,all cases were clinically diagnosed as small renal cell carcinoma with distant metastasis.All patients underwent laparoscopic partial nephrectomy and metastasectomy,and received molecular targeted therapy after operation.The pathological results confirmed clear cell carcinoma in 6 patients and chromophobe renal carcinoma in 2 cases.During the follow-up,metastasis progression was observed in 1 patient.Conclusion Small renal cell carcinoma with distant metastasis is uncommon,especially for patients with high-grade microvascular invasion and pathological sarcomatoid,papillary and chromophobe renal cell carcinoma.Patients with distant metastasis had poorer prognosis than those without metastasis.Early laparoscopic surgery and postoperative molecular targeted therapy can significantly improve the prognosis and patients' quality of life.
引文
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[10]UZZO RG,NOVICK AC.Nephron-sparing surgery for renal tumors:indications,techniques and outcomes[J]J Urol,2001,166(1):6-18
[11]MINERVINI A,CRISTOFANO C,LAPINI A,et al.Histopathologic analysis of peritumoral pseudo capsule and surgical margin status after tumor enueleation for renal cell carcinoma[J].Eur Urol,2009,55:1410-1418.
[12]IACOVELLI R,LANOY E,ALBIGES L,et al.Tumour burden is an independent prognostic factor in metastatic renal cell carcinoma[J].BJU Int,2012,110:1747-1753.
[13]李旭东,吴大鹏,刘润明,等.小肾癌同期远处转移4例报告并文献复习[J].现代泌尿外科杂志,2014,19(6):374-377.
[2]燕翔,丁强,方祖军,等.肾脏偶发癌I临床分析(附116例报告)[J].中华泌尿外科杂志,2004,25(1):5-7.
[3]THOMPSON RH,ORDONEZ M A,IASONOSA,et al.Renal cell carcinoma in young and old patients-is there a difference?[J].J Urol,2008,180(4):1262-1266.
[4]HOLLENBEEK BK,TAUB DA,MILLERIX,et al.National utilization trends of partial nephrectomy for renal cell carcinoma:a case of underutmzation?[J].Urology,2006,67(2):254-259.
[5]RDDAN DN,RAJ GV,POLASCIKTJ.Management of small renal tumors:an overview[J].Am J Med,2001,110(7):558-562.
[6]王文成,马腾腾,王广有,等.312例肾癌的诊治现状[J].中华泌尿外科杂志,1989,10(2):210-212.
[7]ESCHWEGE P,SAUSSINE C,STEICHEN G,et al.Radical nephrictomy for renal cell carcinoma 30mm or less:long-term for low results[J].J Urol,1996,155(4):l196-1199.
[8]IUCIANI LG,CESTARI R,TALLARIGO C.Incidental renal cell carcinoma age and stage characterization and clinical implications:study of 1092patients[J].Urology,2007,12(4):1982-1997.
[9]WUNDERLICH H,REICHELT O,SCHUMANN S,et al.Nephron sparing surgery for renal cell carcinoma 4cm or less in diameter:Indicated or under treated?[J].J Urol,1998,159(5):1465-1469.
[10]UZZO RG,NOVICK AC.Nephron-sparing surgery for renal tumors:indications,techniques and outcomes[J]J Urol,2001,166(1):6-18
[11]MINERVINI A,CRISTOFANO C,LAPINI A,et al.Histopathologic analysis of peritumoral pseudo capsule and surgical margin status after tumor enueleation for renal cell carcinoma[J].Eur Urol,2009,55:1410-1418.
[12]IACOVELLI R,LANOY E,ALBIGES L,et al.Tumour burden is an independent prognostic factor in metastatic renal cell carcinoma[J].BJU Int,2012,110:1747-1753.
[13]李旭东,吴大鹏,刘润明,等.小肾癌同期远处转移4例报告并文献复习[J].现代泌尿外科杂志,2014,19(6):374-377.