摘要
目的探讨上海仁济医院12年收治肾癌病例临床病理特点和治疗方法的变化。方法回顾性分析1999—2010年诊治1923例肾癌患者资料，包括初诊年龄、性别、症状、肿瘤大小、TNM分期、病理亚型、Fuhrman分级及手术方式。将临床资料分3个阶段进行比较分析：第1阶段（1999—2002年）以开放根治手术为主；第2阶段（2003—2006年）保留肾单位手术及腹腔镜手术逐步应用；第3阶段（2007—2010年）保留肾单位手术广泛应用。结果1999—2010年，收治肾癌例数明显增加，由第1阶段267例增至第3阶段1092例。无症状肾癌患者比例由49．8％增至73．6％（P〈0．01），但男女比例（P=0．559）、平均初诊年龄（P=0．138）和青年肾癌（≤40岁）比例（P=0．604）无明显变化。肿瘤平均最大径由6．1cm降至4．8cm（P〈0．01），小肾癌（≤4cm）比例由30．3％（81例）增至54．4％（594例，P〈0．01）。开放手术比例由98．5％（263例）降至73．8％（806例），腹腔镜手术比例由1．5％（4例）升至26．2％（286例，P〈0．01）；根治手术比例由94．8％（253例）降至62．8％（686例）；保留。肾单位手术比例由5．2％（14例）升至34．7％（379例，P〈0．01），其中T1a期保留肾单位手术比例由17．9％（14例）升至57．4％（323例，P〈0．01）。T1a期由0．0％升至14．8％（50例，P〈0．01）。第3阶段开展了肾癌的射频消融治疗占2．5％（27例）。结论1999—2010年肾癌的临床特点及治疗手段已发生变化，肾癌就诊率明显增加，无症状肾癌和小肾癌明显增多，T1a期保留肾单位手术逐渐部分取代根治手术，部分T1a期肿瘤采取射频消融治疗，T1b期肾癌采取保留肾单位手术的例数增加。
Objective To study the evolution of renal cell carcinoma treated in a single institution over the past 12 years. Methods A total of 1923 patients with renal cell carcinoma surgically treated from 1999 to 2010 were included in this study. Age at diagnosis, gender, symptoms, tumor size, TNM stage, histological subtype, Fuhrman grade and type of treatment were compared among 3 periods （ Period 1 ： 1999 - 2002, Period 2 ： 2003 - 2006, Period 3 ： 2007 - 2010）. Results The number of patients grew fasty from 267 cases in the Period 1 to 1092 cases in the Period 3. The incidentally diagnosed cases in- creased significantly from 49.8% to 73.6% （P 〈0.01 ） , while the mean age of patients at diagnosis, the male to female ratio and the proportion of young （ 40 years old） patients were not statistically different. The tumor size at diagnosis gradually decreased from 6.1 cm to 4.8 cm （P 〈 O. O1 ） , and the proportion of small tumors less than 4 em increased remarkably from 30.3% to 54.4% （P 〈0.01 ）. Concerning the surgical approach, open surgery decreased from 98.5% to 73.8% （ P 〈 0.01 ） , and laparoscopic surgery in- creased from 1.50% to 26.2% （P 〈 0.01 ）. Overall, the rate of nephron-sparing surgery increased from 5.2% to 34.7% （P 〈0.01 ） in all cases. The use of nephron-sparing surgery increased significantly from 17.9% to 54.7% in T1a subset and from 0.00% to 14.8% in T1b subset respectively （P 〈 0.01 ）. Further- more, radiofrequency ablation was applied and the percent of this approach reached 2.47% in Period 3. Conclusions The evolution of clinical-pathological characteristics and surgical treatment for renal cell car- cinoma in a single institution is apparent over the last 12 years. With the increase of incidentally diagnosed cases and small renal tumors, nephron-sparing surgery has been widely performed in T1 subset instead of tra- ditional radical nephrectomy.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2012年第12期891-894,共4页
Chinese Journal of Urology
基金
国家自然科学基金（81272841,81072097）,上海市申康医院发展中心资助项目（SHDC12010104）
关键词
肾肿瘤
癌
保留肾单位手术
Kidney neoplasms
Carcinoma
nephron-sparing surgery
