T<sub>2a</sub>期局限性肾癌患者临床、病理特征描述及肿瘤转移影响因素分析

doi:10.19558/j.cnki.10-1020/r.2020.01.003

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摘要 目的：总结T_2a期局限性肾癌的临床特征,筛查肿瘤转移的影响因素。方法：收集2008年1月–2016年9月中国人民解放军总医院泌尿外科接受手术治疗的238例T_2a期局限性肾癌临床资料,总结其特征并采用logistics回归分析肿瘤转移的影响因素。结果：入组患者中男163例（68.5%）,女75例（31.5%）,男女比例2.2∶1,年龄（54.8±11.2）岁,肿瘤最大径（8.3±0.8）cm,透明细胞癌208例（87.4%）,高分化163例（76.9%）,微创率82.4%,肾部分切除（PN）率7.6%,PN无术中中转根治、中转开放或术后切缘肿瘤残留。中位随访时间24（3~77）个月,远处转移27例（10.5%）,死亡7例（2.7%）;其中,18例肾部分切除患者中位随访时间25（3~54）个月,未观察到肿瘤的转移。logistics分析显示肿瘤直径和透明细胞癌病理亚型与肿瘤转移呈显著性相关性。结论：肾透明细胞癌是T_2a期局限性肾癌主要的病理类型,并多数肾癌分化程度较好。T_2a期局限性肾癌行PN并没有增加肿瘤转移风险。肿瘤直径越大,转移风险越高,透明细胞癌转移风险率高于其他病理类型。

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	王强
	王保军
	王云鹏
	刘志佳
	徐俊楠
	唐宇哲
	张旭

关键词 ： T_2a期肾肿瘤, 机器人, 腹腔镜, 肾部分切除术, 肾根治性切除术

Abstract：Objective： To characterize the clinical features of localized renal cell carcinoma in T2a stage and to screen for factors influencing tumor metastasis. Methods： A total of 238 patients with T2a localized renal cell carcinoma treated in Urology Department of the Chinese PLA General Hospital from January 2008 to September 2016 were included. The demographic and clinical data were collected. The logistic regression analysis was used to analyze the influencing factors of tumor metastasis. Results： In this study cohort, there were 163 males (68.5%), and the male to female ratio was 2.2:1, and the median age was (54.8±11.2) years old. There were 208 patents (87.4%) with clear cell carcinoma, and 163 (76.9%) with histologically high differentiated grade, and the maximum diameter in this cohort was (8.3±0.8) cm. In these patients, 82.4% experienced with the minimally invasive surgery, and PN rate was 7.6%. No cases experienced intraoperative conversion from PN, and no cases were proved to be positive tumor margin. The median follow-up time was 24 (3-77) months. There were 27 cases (10.5%) of tumor metastasis, and 7 cases (2.7%) died, Of the 18 cases subject to partial nephrectomy, the patient was followed up for 25 (3-54) months and no tumor metastasis was observed. The logistics analysis showed a significant correlation between tumor metastasis and tumor diameter and histology of clear cell carcinoma. Conclusion： Renal clear cell carcinoma is the main pathological type in T2a stage localized renal cell carcinoma, with relatively better differential grade. PN in localized renal cell carcinoma of the T2a phase does not increase the risk of tumor metastasis. The larger the diameter of T2a renal cancer, the higher the risk of tumor metastasis, and the clear cell carcinoma had higher risk metastasis than other pathological types.

Key words： T_2a stage renal tumor robotic assisted laparoscopic partial nephrectomy radical nephrectomy

收稿日期: 2019-05-21

ZTFLH:

737.11

基金资助:国家自然科学基金（81572878）

通讯作者: 张旭,xzhang@foxmail.com

引用本文:

王强, 王保军, 王云鹏, 刘志佳, 徐俊楠, 唐宇哲, 张旭. T_2a期局限性肾癌患者临床、病理特征描述及肿瘤转移影响因素分析[J]. 微创泌尿外科杂志, 2020, 9(1): 12-18.
WANG qiang, WANG Baojun, WANG Yunpeng, LIU Zhijia, XU Junnan, TANG Yuzhe, ZHANG Xu. T_2a stage localized renal cell carcinoma: clinical features and analysis of impact factors of tumor metastasis. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2020, 9(1): 12-18.

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http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/abstract/abstract1559.shtml 或 http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/Y2020/V9/I1/12

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