Concurrent renal cell carcinoma and urothelial carcinoma: long-term follow-up study of 24 cases

目的 了解肾癌并发尿路上皮癌的临床表现,诊治和预后特点.方法 回顾性分析2005年5月至2015年12月北京大学第一医院诊治的肾癌并发尿路上皮癌患者,收集临床及预后资料,应用Kaplan-Meier生存曲线来评估总生存率.结果 共有24例患者纳入本研究,中位年龄69.5岁(48 ～ 79岁),14例出现血尿.影像学检查发现4例为肾癌并发同侧上尿路尿路上皮癌(UTUC),16例为肾癌并发膀胱癌,1例为肾癌并发同侧UTUC和膀胱癌,2例术前诊断为肾癌,1例术前诊断为输尿管癌.这些患者接受了不同的治疗方式,术后病理均证实肾癌并发尿路上皮癌.中位随访时间是22.5个月.3年总生存率是82.7％.对于肾癌并发膀胱癌,接受肾部分切除者相比根治性肾切除者的生存率无显著性差异(P =0.874).结论 肾癌并发尿路上皮癌比较少见,治疗应该个体化.患者的预后主要受恶性程度更高的那种肿瘤影响.Objective To investigate the clinical manifestation,diagnosis,treatment and outcome of simultaneous occurrence of renal cell carcinoma and urothelial carcinoma.Methods Twenty-four consecutive patients with synchronous renal cell carcinoma and urothelial carcinoma treated in our center from March 2005 to December 2015 were retrospectively reviewed.Their clinical,pathological and prognostic features were evaluated.Kaplan-Meier curves were used to estimate overall survival.Results Patient'age was range from 48 to 79 yrs (median 69.5).Fourteen patients presented with macroscopic hematuria,and 10 patients were asymptomatic.B-ultrasound,computed tomography (CT) and cystoscopy initially indicated renal cell carcinoma concurrent with ipsilateral upper urinary tract urothelial carcinoma (UTUC) in 4 cases,renal cell carcinoma concurrent with bladder tumor in 16 cases,renal cell carcinoma concurrent with both ipsilateral UTUC and bladder tumor in 1 case,renal cell carcinoma in 2 cases and ureter carcinoma in 1 case.Different treatments were performed.The median follow-up time after surgery was 22.5 months.For patients with synchronous renal cell carcinoma and bladder tumor,there was no significant survival difference between patients treated with partial nephrectomy or radical nephrectomy.During follow up,3 patients died of renal cell carcinoma,3 patients died of non-oncological disease and 1 patient died of ureter carcinoma.The 3-year overall survival rate was 82.7％.For patients with synchronous renal cell carcinoma and bladder tumor,there was no significant survival difference between patients treated with partial nephrectomy or radical nephrectomy (P =0.874).Conclusions Concurrence of renal cell carcinoma and urothelial carcinoma is clinically rare.Treatments should be individualized.The prognosis for a patient with synchronous renal cell carcinoma and urothelial carcinoma is associated with the more aggressive one.中国科学引文数据库(CSCD)12940-9439