栏目: 临床医学

摘要
• 摘要:   目的  分析T_1b期肾癌病理学特点，同时探讨该期肾癌行保留肾单位手术的最佳手术切缘。  方法  回顾性分析2013年9月−2017年12月于我院行手术治疗的245例T_1b期肾癌患者的临床及病理资料。  结果  245例患者中男158例，女87例，平均年龄59.6岁，平均肿瘤大小5.3 cm。行根治性肾切除术者174例，保留肾单位手术者71例。术后病理学检查为肾透明细胞癌209例（85.3%），219例（89.4%）患者瘤体周围可见明显假包膜，其中26例（10.6%）患者肿瘤细胞穿透假包膜并侵入周围肾实质，浸润深度在1 mm、1～2 mm和2～3 mm的肿瘤分别为7例（26.9%）、16例（61.5%）和3例（11.5%）。24例（9.8%）患者可见多发性肿瘤。肾部分切除术的平均切缘为5 mm（3～7 mm）。  结论  保留肾单位手术可用于T_1b期肾癌，为避免切缘阳性，切缘距肿瘤表面应至少3 mm。

  关键词:
  • 肾癌 / 
  • 保留肾单位手术 / 
  • 手术切缘 / 
  • 假包膜 
  Abstract:   Objective  To analyze the pathological characteristics and explore the optimal surgical margins (SM) of nephron-sparing surgery (NSS) for stage T_1b renal carcinoma (4–7 cm) on preoperative imaging.  Methods  The clinical and pathological data of 245 cases of stage T_1b kidney cancer from September 2013 to December 2017 were collected and reviewed retrospectively. The radical nephrectomy (RN) was performed on 174 cases and other 71 cases accepted NSS. There were 158 males and 87 females, with a mean age of 59.6 years and mean tumor size of 5.3 cm.  Results  Through postoperative pathological examination, 209 (85.3%) cases were confirmed renal clear cell carcinoma and 219 (89.4%) cases were surrounded with visible peritumoralpseudocapsule (PC). 26 (10.6%) cases of cancerous cells invaded beyond peritumoral PC and into renal parenchyma. The infiltrative depth into renal parenchyma beyond PC was all limited in 3 mm and the cases of ≤1, 1-2 and 2-3 mm were 7 (26.9%), 16 (61.5%) and 3 (11.5%), respectively. Multifocal tumors were discovered in 24 (9.8%) cases. The average resection margin for partial nephrectomy was 5 mm (3-7 mm).  Conclusion  For stage T_1b renal tumors, NSS is acceptable and a 3 mm of surgical margin is safe and suitable to avoid positive SM.

  Key words:
  • Renal tumors / 
  • Nephron-sparing surgery / 
  • Surgical margins / 
  • Pseudocapsule 
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  图  1  不同状态的瘤周假包膜示意图。 HE ×100

  Figure  1.  Schematic diagram of peritumoral pseudocapsule in different states. HE ×100

  A: The pseudocapsule was complete without tumor cell infiltration; B: Tumor cells infiltrated the pseudocapsule but did not penetrate; C: Tumor cells penetrate the pseudocapsule into the renal parenchyma. PC: Pseudocapsule; T: Tumor; K: Kidney

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  图  2  肿瘤原发灶及卫星灶（箭头所示）。 HE ×100

  Figure  2.  Primary tumor foci and satellite foci (arrows). HE ×100

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  图  3  术后病理学检查证实为切缘阳性（黑色箭头所示）。 HE ×100

  Figure  3.  Postoperative pathological examination confirmed that the cutting edge was positive (arrow). HE ×100

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  表  1  pT_1b肾癌患者临床及病理资料（n=245）

  Table  1.   Clinical and pathological characteristics of pT_1b renal cell carcinoma patients (n=245)

  Variable	NSS group (n=71)	RN group (n=174)	P
  Gender/case (%)			0.46
  Male	43 (60.6)	115 (66.1)
  Female	28 (39.4)	59 (33.9)
  Age/yr., median (P25-P75)	64 (31-79)	61 (49-82)	0.62
  Tumor diameter/cm, median　(P25-P75)	5.2 (4.2-7.0)	5.5 (4.5-7.0)	0.22
  Laterality/case (%)			0.06
  Left	40 (56.3)	74 (42.5)
  Right	31 (43.7)	100 (57.5)
  Tumor histologic type/case (%)			0.93
  Clear cell	61 (85.9)	148 (85.1)
  Chromophobe	3 (4.2)	9 (5.2)
  Papillary	5 (7.1)	10 (5.7)
  Others	2 (2.8)	7 (4.0)
  Fuhrman grade/case (%)			0.83
  1	13 (18.3)	30 (17.2)
  2	52 (73.2)	128 (73.6)
  3	5 (7.1)	13 (7.5)
  4	2 (2.8)	2 (1.2)
  Pseudocapsule/case (%)			0.64
  Present	63 (88.7)	156 (89.7)
  Absent	8 (11.3)	16 (9.2)
  Multifocal carcinoma/case (%)			0.81
  Present	6 (8.5)	18 (10.3)
  Absent	65 (91.5)	156 (89.7)
  NSS: Nephron-sparing surgery; RN: Radical nephrectomy

  下载: 导出CSV

  表  2  肿瘤穿透假包膜并侵犯肾实质的最大浸润深度

  Table  2.   The maximum depth of invasion of the tumor through the pseudocapsule and invading the renal parenchyma

  The maximum depth of 　invasion	NSS group (n=71)	RN group (n=174)	P
  ≤1 mm/case (%)	3 (4.2)	4 (2.3)	0.26
  >1-2 mm/case (%)	3 (4.2)	13 (7.5)	0.23
  >2-3 mm/case (%)	1 (1.4)	2 (1.2)	0.79
  >3 mm/case (%)	0 (0)	0 (0)	−
  NSS: Nephron-sparing surgery; RN: Radical nephrectomy

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