Mosele Giulia R, Caggiari Gianfilippo, Scarpa Roberto M, Doria Carlo
Orthopaedic Department, University of Sassari, Sassari, Italy -
Orthopaedic Department, University of Sassari, Sassari, Italy.
Minerva Urol Nefrol. 2017 Apr;69(2):166-172. doi: 10.23736/S0393-2249.16.02809-5. Epub 2016 Oct 21.
Renal cell carcinoma (RCC) is among the ten most common cancers in both men and women. It comprises 2-3% of all malignancies. The most common site for metastasis from RCC is the lung (50% of patients), followed by the skeleton (20% to 50% of patients).
We retrospectively reviewed our consecutive series of 63 patients surgically treated for spinal metastases from RCC. The surgical treatment for spinal metastases varied in each patient. Factors influencing the choice of surgery included age, disease status, symptoms, morbidity of the patient, the location, the number of repetitive lesions and the existence of extra-osseous metastases. For 42 patients (66.66%) the treatment included radiation two weeks after the surgical procedure.
A total of 68 surgical procedures were performed in 63 patients. For all patients we collected data about type of RCC, locations of metastasis, type of spine metastasis, type of surgery and complications. In this way we had an exahustive vision of the natural history of this kind of patients.
Spine metastatic RCC has a poor prognosis. The favorable prognostic factor is solitary spinal metastasis without involvement of visceral organs where the gold standard treatment is corpectomy en bloc. The negative prognostic factors are the presence of one or more pathological fractures and neurological deficits. Bisphosphonate as zoledronic acid reduce significantly skeletal morbidity and significantly prolong time to bone lesion progression in patients with spine metastases from renal cell carcinoma.
肾细胞癌（RCC）是男性和女性中最常见的十种癌症之一。它占所有恶性肿瘤的2%-3%。肾细胞癌最常见的转移部位是肺（50%的患者），其次是骨骼（20%至50%的患者）。
我们回顾性分析了连续63例接受手术治疗的肾细胞癌脊柱转移患者。每位患者的脊柱转移手术治疗方式各不相同。影响手术选择的因素包括年龄、疾病状态、症状、患者的发病率、转移部位、重复病变的数量以及是否存在骨外转移。42例患者（66.66%）在手术后两周接受了放疗。
63例患者共进行了68次手术。我们收集了所有患者关于肾细胞癌类型、转移部位、脊柱转移类型、手术类型和并发症的数据。通过这种方式，我们全面了解了这类患者的自然病程。
脊柱转移性肾细胞癌预后较差。有利的预后因素是孤立性脊柱转移且未累及内脏器官，此时金标准治疗是整块椎体切除术。负面预后因素是存在一处或多处病理性骨折和神经功能缺损。唑来膦酸等双膦酸盐可显著降低肾细胞癌脊柱转移患者的骨骼发病率，并显著延长骨病变进展时间。
