单中心71例嫌色性肾细胞癌的临床诊治与分析

李玉; 项平; 孔令全; 黄涛

doi:10.16766/j.cnki.issn.1674-4152.003144

单中心71例嫌色性肾细胞癌的临床诊治与分析

doi: 10.16766/j.cnki.issn.1674-4152.003144

中国科学技术大学附属第一医院(安徽省立医院)泌尿外科，安徽合肥 230001

基金项目:

安徽省科研编制计划项目 2022AH051256

详细信息

通讯作者:
黄涛，E-mail：dramantony@126.com

中图分类号: R737.11
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出版历程
- 收稿日期: 2023-06-04
- 网络出版日期: 2023-10-19

Clinical diagnosis, treatment and analysis of 71 cases of chromophobe renal cell carcinoma in a single center

Department of Urology, the First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital), Hefei, Anhui 230001, China

摘要

摘要: 目的探讨嫌色性肾细胞癌(chRCC)的临床特征、病理学特点、手术疗效及预后，提高对该病的诊治水平。方法回顾性分析中国科学技术大学附属第一医院2015年6月—2023年3月收治的71例chRCC患者的临床及随访资料，总结临床经验。同时比较肾部分切除(PN)组与根治性肾切除(RN)组围手术期各项指标。结果 71例chRCC患者PN 26例，RN 45例。肿瘤T分期T1a 24例，T1b 31例，T2a 12例，T2b 4例。CT主要表现为肾脏等密度或稍低密度实性占位，动脉期呈轻、中度强化，强化程度低于肾实质，呈缓慢升高状态，静脉期及延迟期强化程度缓慢减退。65例CD117染色61例阳性，1例弱阳性；69例CK7染色62例阳性，1例弱阳性；60例Vimentin染色54例阴性；44例胶体铁染色33例阳性，8例弱阳性；70例Ki-67均呈阳性，中位Ki-67值为4.5%。PN组与RN组的年龄、术前肌酐清除率(Ccr)、术中出血量、术后血红蛋白下降值、术后白蛋白下降值、引流管留置时间、术后住院时间差异无统计学意义(均P＞0.05)。PN组术后Ccr显著优于RN组，且PN组肿瘤最大径、T分期均低于RN组(均P＜0.05)。68例患者成功随访，至随访结束，均为无瘤存活状态。结论 chRCC是一种少见、恶性度低、侵袭性低的肾细胞癌亚型，预后良好。其具有独特的CT影像学表现，常规病理和免疫组化能够确诊。PN在肾功能保护方面优于RN，PN是治疗T1期chRCC安全有效的手术方式。
- 嫌色性肾细胞癌 /
- 诊断 /
- 治疗 /
- 预后
Abstract: Objective To investigate the clinical features, pathological features, surgical efficacy and prognosis of chromophobe renal cell carcinoma (chRCC), and to improve the level of diagnosis and treatment of this disease. Methods Clinical and follow-up data of 71 patients with chRCC from the First Affiliated Hospital of University of Science and Technology of China from June 2015 to March 2023 were retrospectively analyzed. Clinical experience was summarized. Meanwhile, the perioperative indexes of the partial nephrectomy (PN) group and the radical nephrectomy (RN) group were compared. Results There were 26 cases of PN and 45 cases of RN in 71 patients with chRCC. There were 24 cases of T1a, 31 cases of T1b, 12 cases of T2a, and 4 cases of T2b. CT mainly showed isodense or slightly low-density solid space occupying in the kidney, light and moderate enhancement in the arterial phase, and the enhancement degree was lower than the renal parenchyma, showing a slowly increasing state, and the enhancement degree in the venous phase and the delayed phase slowly decreased. Among 65 cases, 61 cases were positive for CD117 staining, and 1 case was weakly positive. Among 69 cases, 62 cases were positive for CK7 staining, and 1 case was weakly positive. Vimentin staining was negative in 54 of 60 cases. Among 44 cases, 33 were positive for colloidal iron staining and 8 were weakly positive. Seventy cases of Ki-67 were all positive, with a median Ki-67 value of 4.5%. There were no statistically significant differences in age, preoperative creatinine clearance (Ccr), intraoperative blood loss, postoperative hemoglobin decline, postoperative albumin decline, drainage indent time and postoperative hospital stay between PN and RN groups (all P > 0.05). The postoperative Ccr in PN group was significantly better than that in RN group, and the maximum tumor diameter and T stage in PN group were lower than those in RN group (all P < 0.05). Sixty-eight patients were followed up successfully, and all of them were tumor free until the end of follow-up. Conclusion chRCC is a rare, low malignant and low invasive subtype of renal cell carcinoma with good prognosis. It has unique CT imaging findings and can be confirmed by routine pathology and immunohistochemistry. PN is superior to RN in renal function protection, and PN is a safe and effective surgical method for treating chRCC at T1 stage.
- Chromophobe renal cell carcinoma /
- Diagnosis /
- Treatment /
- Prognosis

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图 1 chRCC的CT平扫、动脉期、静脉期、延迟期图像

注：A为CT平扫示左肾中下极见一类圆形稍低密度肿块影，局部外突，边界尚清，密度不均，内见坏死影及星芒状瘢痕样低密度影，平扫CT值约34.6 Hu；B为增强CT动脉期肿块轻中度不均匀强化，CT值约108.9 Hu；C、D为增强CT静脉期及延迟期强化程度缓慢减退，CT值分别约97.1 Hu、90.4 Hu。

Figure 1. CT plain scan, arterial, venous and delayed phase images of chRCC

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图 2 chRCC病理HE及IHC染色(×200)

注：A为HE染色；B为CD117染色阳性；C为CK7染色阳性；D为Vimentin染色阴性；E为胶体铁染色阳性。

Figure 2. chRCC pathology HE and IHC staining (×200)

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表 1 PN组和RN组chRCC患者指标比较

Table 1. Comparison of chRCC patients in PN group and RN group

组别	例数	年龄 (x±s，岁)	肿瘤最大径 [M(P₂₅, P₇₅)，cm]	T分期[例(%)]		术前Ccr (x±s，L/min)	术后Ccr (x±s，L/min)
组别	例数	年龄 (x±s，岁)	肿瘤最大径 [M(P₂₅, P₇₅)，cm]	T1期	T2期	术前Ccr (x±s，L/min)	术后Ccr (x±s，L/min)
PN组	26	52.7±10.6	3.0(2.0，4.5)	25(96.2)	1(3.8)	104.1±30.7	85.4±22.9
RN组	45	53.1±12.7	6.0(5.0，9.0)	30(66.7)	15(33.3)	96.8±32.0	63.2±19.3
统计量		-0.134^a	-5.333^b	8.208^c		0.945^a	4.356^a
P值		0.893	＜0.001	0.004		0.348	＜0.001

组别	例数	术中出血量 [M(P₂₅, P₇₅)，mL]	术后血红蛋白下降值 [M(P₂₅, P₇₅)，g/L]	术后白蛋白下降值 [M(P₂₅, P₇₅)，g/L]		引流管留置时间 [M(P₂₅, P₇₅)，d]	术后住院时间 [M(P₂₅, P₇₅)，d]
PN组	26	50(20，50)	11.0(7.8，16.8)	6.9(4.7，10.4)		5(4，6)	7(5，8)
RN组	45	50(25，150)	13.0(7.5，23.0)	7.1(3.7，9.6)		4(4，6)	6(5，8)
统计量		-1.675^b	-0.472^b	< 0.001^b		-1.282^b	-0.067^b
P值		0.094	0.637	0.999		0.200	0.947
注：^a为t值，^b为Z值，^c为χ²值。

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