Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
BJU Int. 2011 Aug;108(3):338-42. doi: 10.1111/j.1464-410X.2010.09771.x. Epub 2010 Nov 17.
• To analyse the clinical characteristics and outcomes of patients who underwent nephrectomy for solitary, isolated metastatic disease to the kidney.
• From July 1989 to July 2009, we identified 13 patients who underwent nephrectomy for solitary metastasis to the kidney. Patients' demographics, intra-operative variables and outcomes are reported.
• The median age at nephrectomy was 52 years (range 33-79). Eleven patients (85%) had an incidentally discovered renal mass, whereas two patients (15%) presented with gross haematuria. • Median time from initial surgery at the primary site to development of metastatic disease to the kidney was 63 months (range 9-136). No patient had evidence of disease at other sites at the time of nephrectomy. In seven patients (54%), the kidney was the first site of recurrence. • The most common primary site was the lung in five patients (38%), followed by the colon in two (15%), chest wall in two (15%) and bone, brain, breast and salivary gland in one patient each (8%). • Of the 14 procedures performed, eight (57%) were partial nephrectomy (PN) and six (43%) were radical nephrectomy (RN). • Four patients died after progression from the primary tumour, all within 2 years of nephrectomy. One patient with a primary chondrosarcoma had no evidence of disease at last follow-up and died from other causes 50 months after nephrectomy. The median follow-up for the eight patients who were alive at last follow-up was 30 months after nephrectomy. Four of these patients had no evidence of disease and four patients were alive with metastatic disease.
• Kidney involvement by metastatic disease can occur as isolated solitary lesions. Some patients will also have the kidney as the first and only site of metastatic involvement. The presence of an isolated renal metastasis should not be considered an end-stage disease, and nephrectomy can be offered for highly selected patients as a therapeutic option.
分析因孤立性、孤立性转移性肾脏疾病而行肾切除术的患者的临床特征和结局。
从 1989 年 7 月至 2009 年 7 月，我们确定了 13 名因孤立性转移至肾脏而行肾切除术的患者。报告了患者的人口统计学、术中变量和结局。
肾切除术时的中位年龄为 52 岁（范围 33-79）。11 名患者（85%）偶然发现了肾脏肿块，而 2 名患者（15%）出现了肉眼血尿。中位时间从原发部位的初次手术到转移性疾病发展到肾脏为 63 个月（范围 9-136）。在肾切除术时，没有患者在其他部位有疾病证据。在 7 名患者（54%）中，肾脏是复发的第一个部位。最常见的原发部位是肺部 5 例（38%），其次是结肠 2 例（15%），胸壁 2 例（15%），骨、脑、乳腺和唾液腺各 1 例（8%）。14 例手术中，8 例（57%）为部分肾切除术（PN），6 例（43%）为根治性肾切除术（RN）。4 名患者在原发肿瘤进展后死亡，均在肾切除术后 2 年内死亡。1 例原发性软骨肉瘤患者在最后一次随访时无疾病证据，在肾切除术后 50 个月死于其他原因。8 名在最后一次随访时仍存活的患者的中位随访时间为肾切除术后 30 个月。其中 4 例患者无疾病证据，4 例患者患有转移性疾病。
肾脏转移性疾病可表现为孤立性孤立性病变。一些患者还将肾脏作为转移受累的第一个也是唯一部位。孤立性肾转移不应被视为终末期疾病，对于高度选择的患者，可以将肾切除术作为一种治疗选择。
