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目的提高对肾嫌色细胞癌(CRCC)的诊治水平,并评估肿瘤坏死灶对CRCC预后的影响。方法回顾性分析2001年3月-2007年8月南方医科大学南方医院进行的257例肾癌手术,分析其中18例CRCC的临床及病理资料(采用吻合度测量系数Kappa),比较术前CT扫描及术后病理检查对肿瘤坏死灶的诊断一致性,观察肿瘤坏死灶与CRCC临床病理指标的关系,并结合文献复习讨论。结果本组病例中CRCC的发病率为7.0%(18/257),患者平均58.3±15.6(17～78)岁,肿瘤直径为5.6±4.8cm;TNM病理分期:T1aN0M0期6例,T1bN0M0期4例,T2N0M0期3例,T3aN0M03例,T3cN1M02例;Fuhrman病理分级:G1-G213例,G3-G45例。共15例获得随访,随访期6～60个月,平均31.1±6.2个月,其中1例于术后7个月出现骨转移,2例于术后10、12个月时出现肝转移,其他随访病例未见转移;术前CT与术后病理对肿瘤坏死灶的诊断基本一致(Kappa=0.76),存在肿瘤坏死灶的CRCC直径多>7cm(P<0.05),且以高分级、高分期肿瘤多见(P<0.05)。结论CRCC大多分期、分级较低,预后相对较好。肿瘤坏死与肿瘤直径、分级、分期相关,术前发现CT坏死灶对预测肿瘤的侵袭性具有重要意义。
Objective To improve the diagnosis and treatment of chromophobe renal cell carcinoma (CRCC) and evaluate the effect of tumor necrosis on the prognosis of CRCC. Methods A retrospective analysis of 257 cases of renal cell carcinoma performed by Nanfang Hospital of Southern Medical University from March 2001 to August 2007 was performed. The clinical and pathological data of 18 cases of CRCC were analyzed with Kappa. The preoperative CT scan was compared. And postoperative pathological examination of tumor necrosis diagnostic consistency, observe the relationship between tumor necrosis and clinical and pathological features of CRCC, combined with the literature review and discussion. Results The incidence of CRCC in this group was 7.0% (18/257), with an average of 58.3 ± 15.6 (17-78) years and a diameter of 5.6 ± 4.8cm. The TNM pathological stage included 6 cases of T1aN0M0, T1bN0M0 of stage 4 Cases, T2N0M0 3 cases, T3aN0M03 cases, T3cN1M02 cases; Fuhrman pathological grading: G1-G213 cases, G3-G45 cases. A total of 15 cases were followed up for 6 to 60 months with an average of 31.1 ± 6.2 months. One case had bone metastasis at 7 months after operation, 2 cases had liver metastasis at 10 and 12 months after operation, and the others Preoperative CT and postoperative pathological diagnosis of tumor necrosis were basically consistent (Kappa = 0.76), the presence of tumor necrosis CRCC diameter> 7cm (P <0.05), and high grade, high stage Tumor more common (P <0.05). Conclusion Most of the staging of CRCC, lower grade, the prognosis is relatively good. Tumor necrosis and tumor diameter, grading, staging related to preoperative CT necrosis found in the prediction of tumor invasion is of great significance.