摘要探讨终末期肾病合并肾细胞癌(ESRD?RCC)的临床病理学特点及预后.方法收集2009年1月至2018年8月青岛大学附属医院(10例)和海军第九七一医院(5例)ESRD?RCC患者的临床病理资料,分析其临床病理特点及预后,并复习相关文献.结果 15例中男14例,女1例,发病年龄38~78岁(平均年龄51岁,中位年龄49岁).所有患者均有慢性肾功能衰竭病史(7~192个月),其中9例曾行透析治疗(6~132个月).大体检查:12例肿瘤组织边界清楚,直径1.8~11.0 cm,2例为多灶性,1例肾脏广泛出血、肿瘤不明显.组织学诊断:肾透明细胞癌9例(1例伴肉瘤样分化)、获得性囊性肾病相关性肾细胞癌(ACKD?RCC)4例、乳头状肾细胞癌(Ⅰ型)2例.15例随访时间3~120个月,4例因远处转移(2例,1例伴灶状肉瘤样分化)或肾衰竭(2例)于术后6~60个月(平均30个月)死亡,11例术后生存3~120个月(平均40.8个月),未见复发或远处转移.结论 ESRD?RCC多见于青年男性,自确诊为慢性肾功能衰竭至诊断为肾细胞癌的时间长短不一,大多因体检发现,组织学类型既可以表现为与散发性肾细胞癌一致的形态学特点,也可以表现为独特的病理组织类型,以肾透明细胞癌和ACKD?RCC最多见,癌组织易出血、坏死.定期体检、早期发现、及时治疗会让患者获得良好的预后,但肿瘤体积较大、伴肉瘤样分化时预后较差.

abstractsinvestigate the clinicopathological characteristics and prognosis of renal cell carcinoma (RCC) in patients with end?stage renal disease (ESRD). Methods The clinicopathological data of patients of renal cell carcinoma arising in end?stage renal disease were collected from the Affiliated Hospital of Qingdao University (ten cases) and 971 Hospital of PLA Navy (five cases) from January 2009 to August 2018. Results Among 15 patients, 14 were male and 1 was female, and the age ranged from 38 to 78 years (mean 51 years, median 49 years). All patients had history of chronic renal failure (7-192 months), including 9 patients treated with hemodialysis for 6 to 132 months. In 12 cases the tumor border was distinct and the tumor size ranged from 1.8 to 11.0 cm. Two cases were multifocal and one case showed extensive renal hemorrhage with an inconspicuous tumor mass. Microscopically, 9 cases were clear cell reanl cell carcinoma including one with sarcomatoid differentiation, 4 were acquired cystic kidney disease?associated(ACKD?RCC) and two were papillary renal cell carcinoma. All patients had a follow?up of 3 to 120 months. Four patients died during a follow?up of 6 to 60 months (mean 30 months) as a result of extensive distant metastases (two cases) and renal failure (two cases), while other eleven patients were alive without tumor recurrence or metastasis (median 40.8 months of follow?up ranging from 3 to 120 months). Conclusions ESRD?RCC is more often seen in younger male patients. The time intervals from the onset of chronic renal failure to the diagnosis of renal cell carcinoma differ and tumors are frequently incidental findings. The histological types can be sporadic renal cell carcinoma or unique ACKD?RCC. Tumors are often hemorrhagic and necrotic. Routine physical examination and early detection could benefit ESRD?RCC patients. ESRD?RCC may have a favorable prognosis despite of a large tumor size or the presence of sarcomatoid differentiation.