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目的提高对乳头状肾细胞癌(PRCC)的诊治水平,评估PRCC手术后的预后情况。方法分析我院2004年5月~2012年12月期间收治的52例PRCC癌患者的病例资料,并进行术后的随访。结果 52例PRCC患者(男39例,女13例,中位年龄50.3岁)中,10例因血尿就诊,18例因腰痛就诊,既有血尿又有腰痛者为4例,其余20例为体检时偶然发现。肿瘤直径平均5.9 cm(1.4~15 cm)。其中10例病人(肿瘤直径<5 cm,无转移征象且位于肾的上极或者下极)行保留肾单位手术,42例行肾肿瘤根治性切除术。TNM分期分别为:Ⅰ期有37例,Ⅱ期有9例,Ⅲ期有2例,Ⅳ期有4例。共有44例获得术后随访,随访时间10~122个月,平均随访46.9个月。10例行保留肾单位手术的病人均存活,平均随访时间50.9个月(19~81个月)。有4例分别于术后10、16、16、30个月死亡。术后1年存活率为97.7%(43/44),3年存活率为87.5%(28/32),5年存活率为77.8%(14/18)。结论乳头状肾细胞癌的临床表现无特异性,病人来医院就诊时肿瘤大多数处于Ⅰ期,治疗上以手术切除治疗为主,术后给予免疫制剂治疗,病人预后较好。
Objective To improve the diagnosis and treatment of papillary renal cell carcinoma (PRCC) and evaluate the prognosis of PRCC after surgery. Methods The data of 52 patients with PRCC who were treated in our hospital from May 2004 to December 2012 were analyzed and followed up. Results Of the 52 PRCC patients (39 males and 13 females, the median age was 50.3 years), 10 were treated by hematuria and 18 were treated by low back pain. Four patients had both hematuria and low back pain, and the remaining 20 were physical examinations Occasionally found. Tumor diameter average 5.9 cm (1.4 ~ 15 cm). Among them, 10 patients (tumor diameter <5 cm, no metastasis and located in the upper pole or lower pole of the kidney) were treated with nephron operation and radical nephrectomy was performed in 42 patients. TNM staging were as follows: stage Ⅰ 37 cases, stage Ⅱ 9 cases, stage Ⅲ 2 cases, stage Ⅳ 4 cases. A total of 44 patients were followed up for 10 to 122 months with a mean follow-up of 46.9 months. Ten patients who underwent nephron surgery survived with an average follow-up time of 50.9 months (19-81 months). 4 cases died at 10, 16, 16 and 30 months respectively. The survival rate at 1 year after operation was 97.7% (43/44). The 3-year survival rate was 87.5% (28/32) and the 5-year survival rate was 77.8% (14/18). Conclusion The clinical manifestations of papillary renal cell carcinoma are nonspecific. Most of the patients are in stage Ⅰ when they come to the hospital for treatment. Surgical resection is the main treatment and immunotherapy is given after surgery. The prognosis of the patients is good.