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目的 肾细胞癌多中心病灶是导致保肾手术后局部复发的主要原因之一。本项研究旨在探讨华人肾细胞癌多中心灶的发病率及相关因素。方法 肾癌根治术标本 10 2例 ,间隔 3mm分层切开 ,检查每个切面 ,原发灶外可疑组织取材镜检 ,确认肾癌者为多中心灶阳性。然后在每个层面 ,假包膜外 15mm的肾组织及肾门组织连续切片镜检确定假包膜完整性、镜下多中心灶 (直径≤ 5mm的多中心灶 )及肾门淋巴结、血管浸润情况。同时评估肾癌多中心性与其它病理指标的关系。结果 本组多中心灶发生率为 15 7% ,原发灶直径≤ 4 0cm组明显低于 4 0cm以上组 (4 9% ,2 / 41vs 2 3 0 % ,14 / 6 1;χ2 =6 0 5 5 ,P =0 0 14 )。无血管浸润组为 9 8% (8/ 82 ) ,明显低于有血管浸润组 (40 0 % ,8/ 2 0 ) ,P =0 0 0 3(Fisher精确概率法 )。假包膜完整组为 1 9% (1/ 5 3) ,明显低于假包膜不完整组 (30 6 % ,15 / 49) (χ2 =15 885 ,P=0 0 0 0 )。原发灶分级、分期、细胞类型及淋巴结浸润与多中心病灶相关性无显著意义 ,Logistic多元回归分析显示血管浸润和包膜不完整是多中心病灶的显著性预测因素 (P值分别为 0 0 0 5 ,0 0 2 3)。结论 本组结果与之前国外的研究报道一致。多中心病灶发生率与原发灶直径、假包膜完整性及血管?
Purpose Renal cell carcinoma multicenter lesions are one of the main causes of local recurrence after kidney-preserving surgery. This study aimed to investigate the incidence and related factors of multinocular foci in Chinese renal cell carcinoma. Methods 102 cases of radical nephrectomy were dissected and dissected 3mm intervals. Each section was examined. The suspicious tissues outside the primary tumor were examined microscopically to confirm the positive of polycystic. Then at each level, pseudocapsule integrity was determined by microscopic examination of 15 mm of kidney and hilar tissue outside the capsule, with microscopic multifocal (multicentric diameter ≤ 5mm) and renal hilar lymph nodes, vascular infiltration Happening. At the same time, we evaluated the relationship between multicentricity of renal cell carcinoma and other pathological parameters. Results The incidence of multifocal foci in this group was 15.7%. The diameter of primary foci ≤ 40 cm was significantly lower than that of more than 40 cm (49%, 2/41 vs 230%, 14/61; χ2 = 60 5 5, P = 0 0 14). The percentage of vascular infiltration group was 9.8% (8/82), which was significantly lower than that of vascular infiltration group (40.0%, 8/20), P = 0 0 3 (Fisher exact probability method). The percentage of pseudocapsules in the intact group was 19% (1/5 3), which was significantly lower than that in the pseudocapsule group (30 6%, 15/49) (χ2 = 15 885, P = 0 0 0 0). There was no significant correlation between primary tumor grade, stage, cell type and lymph node infiltration and multi-center lesion. Logistic multiple regression analysis showed that vascular invasion and incomplete capsule were significant predictors of multi-center lesion (P = 0 0 0 5, 0 0 2 3). Conclusion This group of results consistent with previous studies abroad. The incidence of multi-center lesions and primary diameter, pseudocapsule integrity and blood vessels?