Diagnosis and treatment of multilocular cystic renal cell carcinoma:a study of 22 cases

目的分析多房囊性肾细胞癌病例的临床资料.方法 1998年1月至2002年12月,北京大学第一医院泌尿外科共收治482例肾癌患者,其中多房囊性肾细胞癌22例,总结临床资料进行分析.结果多房囊性肾癌占同期肾癌病例的4.56%,男女比例是2.67∶ 1,与同期非多房囊性肾癌患者比较(男∶女为2.09∶ 1),其性别构成差异无显著意义(P>0.05),但其平均年龄(46.6岁)低于后者(57.83岁),P<0.01.其中pT1N0M0期肿瘤6例,pT2N0M0期肿瘤15例,pT3bN0M0期肿瘤1例;G1级肿瘤5例,G2级肿瘤17例.结论多房囊性肾细胞癌是肾癌的一种特殊类型,诊断主要依据影像学检查,术前鉴别非常困难.对诊断不清的病例,尤其对于Bosniak分类在三级或以上者,行术中冰冻病理检查或采用保留肾组织的手术治疗,可使患者受益.To summarize the diagnosis and treatment of multilocular cystic renal cell carcinoma (MCRCC), a special subtype of renal cell carcinoma.The clinical data of 22 cases of MCRCC diagnosed and treated from January 1998 to December 2002 in the First Hospital of Peking University were analyzed retrospectively.482 patients with renal cell carcinomas were hospitalized during that period with a male-to-female ratio of 2.09:1. Out of the 482 cases 22 cases (4.56%) were classified as MCRCC with a male-to-female ratio of 2.67:1, not significantly different from that of the general group of renal cell carcinoma patients (P > 0.05). The mean age of the patients of MCRCC was 46.6 years, significantly lower than that of the patients with other types of renal cell carcinomas (57.83 years, P< 0.01). Eighteen cases were diagnosed correctly as renal carcinomas before operation. Six patients (27%) were at the stage pT(1)N(0)M(0), 15 (68%) at the stage pT(2)N(0)M(0), and 1 (5%) at the stage pT(3)bN(0)M(0). The classification according to the tumor nuclear grading system showed 5 carcinomas (23%) of tumor nuclear grade 1, 17(77%) are of tumor nuclear grade 2. Eighteen patients underwent radical renal nephrectomy and 4 underwent partial nephrectomy.The preoperative diagnosis of MCRCC, difficult to be differentiated from other cystic renal diseases, mainly depends on imaging studies. Intraoperative frozen-section or nephron sparing surgery will benefit the patients if the preoperative diagnosis is unclear, especially for the patients of category 3 or 4 of Bosniak's system.PubMed中文核心期刊要目总览(PKU)中国科学引文数据库(CSCD)09740-7428