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目的分析以转移灶为首发临床表现肾癌患者的临床特征。方法回顾性分析了32例以转移灶为首发临床表现肾癌患者的临床资料,男性24例,女性8例,中位年龄56岁。结果患者以骨转移灶(下肢痛4例、胸痛3例、背痛3例、枕部结节3例、胸壁肿物2例、肩疼1例、髂区痛1例、下肢麻木1例)、肺转移灶(咳嗽7例、咳血2例、体检发现肺占位2例)、脑转移灶(头痛1例、头晕1例)及淋巴结转移灶(颈部肿物1例)的症状和体征为首发临床表现。多发转移27例、单发转移5例。透明细胞癌31例、乳头状癌1例。肾肿瘤中位直径7.5cm。有肾原发灶病理资料的28例患者中,T1期7例、T2期12例、T3a期9例,G12例、G211例、G312例、G43例,11例伴脉管瘤栓。全身治疗为干扰素-α+白细胞介素-Ⅱ(24例)、索拉非尼(4例)及舒尼替尼(4例)。28例行减瘤肾切除术,11例行转移灶姑息放疗或切除。本组30例获随访,23例死亡,患者的中位生存期10个月(4个月～7年)。2例单发骨转移的患者,经全身治疗联合减瘤肾切除及转移灶切除或放疗,分别无瘤生存7年及19个月。结论以转移灶为首发临床表现的肾癌患者,骨转移造成的临床表现最为常见。患者多为多发转移、伴不良病理预后因素,预后差、生存期短。对孤立骨转移的患者,全身治疗辅以原发灶及转移灶的姑息治疗,部分患者可能长期生存。
Objective To analyze the clinical features of patients with renal cell carcinoma whose first clinical manifestation is metastasis. Methods A retrospective analysis of 32 cases of metastases as the first clinical manifestations of renal cell carcinoma in patients with clinical data, 24 males and 8 females, the median age of 56 years. Results The patients had bone metastases (4 cases of lower limb pain, 3 cases of chest pain, 3 cases of back pain, 3 cases of occipital nodules, 2 cases of chest wall tumor, 1 case of shoulder pain, 1 case of iliac region pain and 1 case of lower limb numbness) , Lung metastases (7 cases of cough, 2 cases of hemoptysis, 2 cases of lung involvement in the physical examination), brain metastases (1 case of headache, 1 case of dizziness) and lymph node metastasis (1 case of neck tumor) and Signs for the first clinical manifestations. 27 cases of multiple metastases, single metastasis in 5 cases. 31 cases of clear cell carcinoma and 1 case of papillary carcinoma. The median diameter of renal tumors 7.5cm. There were 7 cases of T1, 12 cases of T2, 9 cases of T3a, G12 cases, G211 cases, G312 cases, G43 cases and 11 cases with vascular tumor thrombus in 28 patients with pathological data of primary renal lesions. Systemic treatment for interferon-α + interleukin-Ⅱ (24 cases), sorafenib (4 cases) and sunitinib (4 cases). Twenty-eight cases underwent nephrectomy and 11 cases underwent palliative radiotherapy or resection. The group of 30 patients were followed up, 23 patients died, the median survival of patients 10 months (4 months to 7 years). Two patients with single bone metastasis were treated with systemic therapy combined with nephrectomy and metastasis resection or radiotherapy, and survived for 7 years and 19 months respectively. Conclusion The metastatic lesions as the first clinical manifestations of renal cell carcinoma, the most common clinical manifestations caused by bone metastases. Patients with multiple metastasis, with poor prognosis factors, poor prognosis, short survival. In patients with isolated bone metastasis, systemic therapy is supplemented with palliative treatment of primary and metastatic sites, and some patients may survive long-term.