摘要
目的探讨高级别肾透明细胞癌的CT检查特点及其相关预后因素。
方法分析我院2012年11月至2017年4月收治的141例行根治性肾切除术治疗的肾透明细胞癌患者的病例资料。男102例，女39例。年龄30～86岁。肿瘤位于左侧73例，右侧68例。肿瘤大小1.6～12.7 cm。临床分期T1a期50例，T1b期67例，≥T2期24例。患者术前均行CT检查。根据术后病理检查核分级将患者分为高级别组（Ⅲ～Ⅳ级）和低级别组（Ⅰ～Ⅱ级），比较两组的临床资料、CT检查结果（肿瘤大小、包膜情况、CT值、肿瘤有无分叶及出血坏死）、术后生存情况。
结果本研究141例的CT检查示109例肿瘤包膜完整，85例肿瘤可见分叶，102例肿瘤可见出血坏死；平扫CT值为10～72 HU，平均35.4 HU；增强扫描CT值32～308 HU，平均102.1 HU。术后病理检查核分级为高级别组66例，低级别组75例。高级别组与低级别组的CT检查肿瘤包膜完整例数[44例（33.3%）与65例（13.3%）]和平扫CT值[（38.9±1.1）HU与（32.3±1.1）HU]比较差异均有统计学意义（均P〈0.01）。高级别组T1期和≥T2期患者例数分别为46例和20例，低级别组分别为71例和4例，两组比较差异有统计学意义（P〈0.01）。本组141例术后随访2～58个月，平均26.4个月。高级别组与低级别组总体生存率分别为92.4%和100.0%，差异有统计学意义（P〈0.05）。高级别组和低级别组中T1a、T1b、≥T2期患者的总体生存率分别为90.9%和100.0%、94.3%和100.0%、90.0%和100.0%，差异均无统计学意义（均P〉0.05）。
结论高级别肾透明细胞癌的CT检查可见肿瘤包膜多不完整，平扫CT值较高。肾透明细胞癌的病理核分级可以提示肿瘤细胞的恶性程度高低与预后密切相关。
ObjectiveInvestigating the CT features and related prognostic factors of high-grade renal clear cell carcinoma.
MethodsThe data of 141 patients with renal clear cell carcinoma treated by radical nephrectomy in our hospital from November 2012 to April 2017 were analyzed retrospectively. There were 102 males and 39 females. Age from 30 to 86 years old. The tumors were located in the left side in 73 cases and 68 in the right. The tumor size ranged from 1.6 cm to 12.7 cm. 50 cases of clinical stage T1a, stage T1b 67 cases, 24 cases above T2.All patients had CT examination before operation. According to the postoperative pathological nuclear grade, patients were divided into high grade group （Ⅲ-Ⅳ） and low grade group （grade Ⅰ-Ⅱ）, clinical data and CT findings were compared between the two groups （tumor size, capsule, CT, with or without leafs, with or without hemorrhagic necrosis）, survival situation after the operation.
ResultThe results of CT examination of 141 cases of this study indicated there were 109 cases of complete capsule, 85 cases of tumor showed lobulation, 102 cases of tumor showed hemorrhagic necrosis, the average CT value is 10-72 HU, 35.4 HU in average; enhanced CT value is 32-308 HU, 102.1 HU in average. After pathological examination, the nuclear classification was 66 cases in high grade group and 75 cases in low grade group. The CT examination in the high grade group and the low grade group showed the number of cases with complete capsule [44 cases （33.3%）vs.65 cases （13.3%）] and plain CT scan value [（38.9±1.1） HU） vs. （32.3±1.1） HU], the difference was statistically of significance （P〈0.01）. The high level of patients in group T1 and group above T2 stage were 46 cases and 20 cases. And the cases of low grade group were 71 cases and 4 cases, there was significant difference between two groups （P〈0.01）. The 141 cases were followed up for 2-58 months, with an average of 26.4 months. There was statistical significance difference between the two groups of T1 patients and patients above T2（P〈0.01）. The results of CT examination were compared. There were significant differences in the case of intact capsule and the value of CT scan （P〈0.01）. The overall survival rate between the two groups was statistically significant （P〈0.05）.
ConclusionsThe CT examination of high-grade renal cell carcinoma shows that most of the capsule is not complete and the CT value of the scan is much higher.The pathological grading of renal cell carcinoma indicates the malignancy of tumor cells, which is closely related to prognosis.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2017年第7期519-522,共4页
Chinese Journal of Urology
基金
基金项目：国家自然科学基金（81172438）
关键词
肾透明细胞癌
高级别
影像学
预后因素
Renal clear cell carcinoma
High grade
Iconography
Prognostic factors
