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目的 探讨肾癌骨转移的临床特点及治疗效果。 方法 对 2 6例肾癌骨转移患者先期行辅助性肾切除后 ,根据骨转移情况不同分三组进行治疗。第 1组 :骨孤立转移灶 12例 ,行彻底切除 ;第 2组 :多发骨转移有潜在性病理骨折或截瘫危险患者 8例 ,选择性行骨病灶肿瘤囊内刮除或椎板减压 +固定术 ;第 3组 :多发骨转移患者 6例 ,骨转移病灶未行手术治疗。 3组均接受系统性免疫治疗。随访时间 4～ 6 6个月 ,平均 (45 .8± 11.7)个月 ,分析三组临床资料及治疗效果。 结果 第 1组 1、3、5年生存率分别为 83%、75 %、5 8% ,平均生存期 (48.5± 6 .7)个月、半数生存期 (37± 13.2 )个月 ,均高于 2、3组。生存曲线比较 ,1组与 2、3组差别有显著性意义 (P <0 .0 5 ) ,2、3组之间比较差别无显著性意义 (P >0 .0 5 )。第 3组中出现病理性骨折和截瘫各 1例。 结论 肾癌骨转移患者除实施辅助性肾切除 +辅助性治疗外 ,有指征的针对骨转移病灶进行手术可提高肾癌骨转移患者的生存期或生存质量。
Objective To investigate the clinical features and therapeutic effect of renal cancer with bone metastases. Methods Twenty-six patients with metastatic renal cell carcinoma underwent primary nephrectomy and divided into three groups according to the bone metastasis. Group 1: isolated bone metastases in 12 cases, complete removal of the line; Group 2: multiple bone metastases potential pathological fracture or paraplegia in 8 patients with selective crab lesion tumor cyst curettage or lamina decompression + Fixation; Group 3: 6 cases of multiple bone metastases, bone metastases were not surgically treated. All three groups received systemic immunotherapy. The follow-up time ranged from 4 to 66 months, with an average of (45.8 ± 11.7) months. The clinical data and therapeutic effects of the three groups were analyzed. Results The 1, 3, 5-year survival rates of group 1 were 83%, 75%, 58% respectively, mean survival time was (48.5 ± 6.7) months and half survival time was 37 ± 13.2 months In 2,3 groups. There was no significant difference between the two groups (P> 0.05). There was no significant difference between the two groups (P> 0.05). In group 3, pathological fractures and paraplegia occurred in 1 case. Conclusion In addition to the implementation of adjuvant nephrectomy and adjuvant therapy, there are indications that surgery for bone metastases may improve the survival or quality of life of patients with bone metastases of renal cell carcinoma.