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背景与目的:肾细胞癌是致死率最高的泌尿系统肿瘤,肾包膜侵犯状况可能与肾癌的临床病理特征及预后相关,但目前在这方面的研究很少。本研究探讨了肾包膜侵犯状况对于肾癌临床症状及分期的意义。方法:根据肿瘤与肾包膜之间的关系把肾包膜侵犯状况分为浸润而未穿透包膜和浸润且穿透包膜。回顾分析2006年在我科接受手术治疗的经病理确诊的101例连续肾癌病例的临床症状、术后病理显示的肾包膜侵犯状况以及TNM分期(AJCC2002年版),并比较3者之间的联系。结果:55例为体检发现,24例诉腰痛,18例有肉眼或镜下血尿,14例有恶液质等全身症状或者伴有转移症状。大体标本77例肿瘤直径≤7cm,50例≤4cm。病理T1期68例,T2期9例,>T2期24例,其中N1-2或M1期的有19例。24例主诉腰痛的病例,肿瘤均未穿透肾包膜;而11例穿透肾包膜的,患者均无腰痛主诉。对于≤4cm的肾癌,腰痛与肾包膜穿透与否无明显相关;当肿瘤>4cm时,29%(10/35)例无腰痛主诉的病例肿瘤已穿透肾包膜;当肿瘤>7cm时,53%(8/15)例无腰痛主诉的病例中肿瘤穿透肾包膜;有转移症状或全身症状的病例,43%(6/14)肿瘤穿透肾包膜;无转移症状或全身症状的病例中,6%(5/87)肿瘤穿透肾包膜。40%(40/101)的病例出现肾包膜浸润,其中11例穿透肾包膜;在肿瘤>7cm的病例中,71%(17/24)出现肾包膜浸润。当肾癌局部未穿透肾包膜时,是否有包膜浸润对于肿瘤的淋巴结或内脏器官的转移无影响(4/29vs9/61,P>0.05);当肾癌浸润肾包膜时,如无进一步的肾包膜穿透,则肿瘤转移显著减少(6/11vs4/29,P<0.01)。结论:就诊时腰痛主诉提示肾癌可能尚为局限性病变,对于较大的肾脏占位,如无腰痛主诉,则肿瘤可能已穿透肾包膜。肾包膜侵犯状况与肾癌的临床症状和病理分期有关联。肾包膜浸润在肾癌中比较常见,尤其对于较大的肿瘤,但穿透肾包膜的肿瘤很少。仅仅肾包膜浸润而不穿透不增加肾癌诊断时出现转移的概率,肾包膜的存在一定程度上减少了肿瘤的转移,在限制肿瘤扩散中有一定的保护性作用。
BACKGROUND & OBJECTIVE: Renal cell carcinoma is the most lethal urologic tumor. The renal capsule invasion may be related to the clinicopathological features and prognosis of renal cell carcinoma, but there are few studies in this area. This study explored the renal capsule invasion of renal cell carcinoma clinical symptoms and staging significance. Methods: According to the relationship between the tumor and the renal capsule, the renal capsule invasion was divided into infiltration without penetrating the capsule and infiltration and penetrating the capsule. We retrospectively analyzed the clinical symptoms of 101 consecutive cases of renal cell carcinoma confirmed by pathology in our department who underwent surgery in our department in 2006 and the renal capsule invasion status and TNM stage after operation (AJCC 2002 edition) contact. Results: 55 cases were found for physical examination, 24 cases complained of back pain, 18 cases of macroscopic or microscopic hematuria, 14 cases of systemic symptoms such as cachexia or associated with metastatic symptoms. 77 specimens of gross tumor diameter ≤ 7cm, 50 cases ≤ 4cm. There were 68 cases of pathological T1, 9 cases of T2, 24 cases of> T2, of which 19 cases were in N1-2 or M1. Twenty-four patients complained of low back pain and the tumors did not penetrate the renal capsule. In 11 patients who penetrated the renal capsule, none of the patients complained of low back pain. For ≤4cm of renal cancer, there was no significant correlation between low back pain and renal capsule penetration. When the tumor> 4cm, 29% (10/35) of the cases without low back pain complained of tumor penetrated the renal capsule. When the tumor> At 7 cm, tumors penetrated the renal capsule in 53% (8/15) of the cases without complaints of low back pain; 43% (6/14) of the patients with metastatic or systemic symptoms had no evidence of metastasis Or systemic symptoms, 6% (5/87) tumors penetrated the renal capsule. In 40% (40/101) of the cases, there was renal capsule infiltration, of which 11 cases penetrated the renal capsule; in 7% of cases of tumors> 71% (17/24) showed renal capsule infiltration. When renal cell carcinoma did not penetrate into the renal capsule, there was no effect of envelope invasion on the metastasis of lymph nodes or internal organs (4/29 vs 9/61, P> 0.05). When renal cell carcinoma infiltrates the renal capsule, Without further renal capsule penetration, tumor metastasis was significantly reduced (6/11 vs 4/29, P <0.01). CONCLUSIONS: The main complaint of low back pain at presentation is that kidney cancer may still be a localized lesion, and for large kidney masses, such as a low back pain complaint, the tumor may have penetrated the renal capsule. Renal capsule invasion and renal cell carcinoma of the clinical symptoms and pathological staging associated. Renal capsule infiltration is more common in kidney cancer, especially for larger tumors, but there are few tumors that penetrate the renal capsule. Only the renal capsule infiltration without penetration does not increase the probability of renal cell carcinoma metastasis diagnosis, the existence of the renal capsule to some extent reduce the tumor metastasis, in limiting the spread of the tumor has a protective effect.