去分化脂肪肉瘤的超声表现与鉴别诊断目的：探讨去分化脂肪肉瘤（DDLS）的超声表现，以提高对其的诊断准确性。方法：回顾性分析经病理证实的 15 例 DDLS 患者的超声资料，总结其超声表现并与病理结果进行对照。结果：15 例患者中，肿瘤位于腹膜后 12 例，腹腔 3 例；肿瘤最大径 4.0～22.0cm，平均 10.5cm；边界清楚 10 例，不清楚 5 例；形态规则 10 例，不规则 5 例；内部回声不均匀 13 例，均匀 2 例；均可见低回声区，其中 10 例呈分叶状，6 例呈不规则形；瘤内可见多发斑片状、条索状强回声，后方伴声影，3 例可见粗大钙化；彩色多普勒血流成像（CDFI）显示肿瘤内部及周边可见丰富血流信号，动脉血流阻力指数（RI）为 0.60～0.80。手术病理结果显示，DDLS 均为多形性脂肪肉瘤与去分化区域共存，其中黏液样变 6 例，多形性脂肪肉瘤成分 3 例，骨、软骨及横纹肌样分化各 1 例，纤维组织增生 3 例，灶性坏死 2 例。结论：DDLS 的超声表现具有一定特征性，表现为形态不规则、内部回声不均匀、可见多发斑片状、条索状强回声，后方伴声影，彩色多普勒血流成像显示肿瘤内部及周边血流丰富，RI 较低，有助于术前诊断。但需与其他腹膜后及腹腔来源的软组织肿瘤相鉴别，最终诊断需依靠病理检查。

Impact of sarcopenia on post-operative outcomes following nephrectomy and tumor thrombectomy for renal cell carcinoma with inferior vena cava thrombus.

机构信息

Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.

Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.

出版信息

Jpn J Clin Oncol. 2021 Apr 30;51(5):819-825. doi: 10.1093/jjco/hyaa275.

DOI:10.1093/jjco/hyaa275

PMID:33558883

Abstract

OBJECTIVE

Sarcopenia is associated with oncological outcomes in various types of cancer. However, the impact of sarcopenia in renal cell carcinoma with inferior vena cava thrombus remains unclear. We herein evaluated the prognostic significance of sarcopenia for renal cell carcinoma with inferior vena cava thrombus following nephrectomy and thrombectomy.

METHODS

Patients who underwent nephrectomy and thrombectomy for renal cell carcinoma with inferior vena cava thrombus at our department between 2004 and 2019 were retrospectively evaluated. Their sarcopenic status, determined by sex, body mass index and skeletal muscle index, was calculated using pre-surgical radiographic imaging. We compared the post-operative cancer-specific survival and overall survival, surgical data and duration of post-operative hospitalization of sarcopenic and non-sarcopenic patients.

RESULTS

Out of 83 patients, 54 (65%) were sarcopenic. Sarcopenic patients had significantly shorter cancer-specific survival (median: 33.3 months vs. not reached, P = 0.0323) and overall survival (32.0 months vs. not reached, P = 0.0173) than non-sarcopenic patients. Furthermore, multivariate analyses showed that sarcopenia was an independent factor for cancer-specific survival (hazard ratio: 2.76, P = 0.0212) and overall survival (hazard ratio: 2.93, P = 0.014). The incidence rate of surgical complications (any grade: 35.2% vs. 27.6%, P = 0.482; grades ≥ 3: 7.4% vs. 10.3%, P = 0.648) or duration of post-operative hospitalization (median: 11 vs. 10 days, P = 0.148) was not significantly different between sarcopenic and non-sarcopenic patients.

CONCLUSIONS

In conclusion, this study showed that sarcopenia was an independent prognostic factor for renal cell carcinoma with inferior vena cava thrombus after nephrectomy and tumor thrombectomy. Thus, sarcopenia evaluation can be utilized as an effective prognosticator of post-operative survival.

摘要

目的

肌肉减少症与多种癌症的肿瘤预后相关。然而，在肾细胞癌合并下腔静脉癌栓患者中，肌肉减少症的影响尚不清楚。本研究旨在评估肾细胞癌合并下腔静脉癌栓患者行肾切除术和瘤栓切除术治疗后，肌肉减少症的预后意义。

方法

回顾性分析 2004 年至 2019 年在我院行肾切除术和瘤栓切除术治疗的肾细胞癌合并下腔静脉癌栓患者。使用术前影像学检查计算患者的性别、体质指数和骨骼肌指数等指标的肌肉减少症状态。比较肌肉减少症和非肌肉减少症患者的术后癌症特异性生存率和总生存率、手术数据和术后住院时间。

结果

83 例患者中，54 例（65%）为肌肉减少症患者。肌肉减少症患者的癌症特异性生存率（中位：33.3 个月 vs. 未达到，P=0.0323）和总生存率（32.0 个月 vs. 未达到，P=0.0173）明显短于非肌肉减少症患者。此外，多因素分析显示，肌肉减少症是癌症特异性生存率（风险比：2.76，P=0.0212）和总生存率（风险比：2.93，P=0.014）的独立预后因素。手术并发症发生率（任何等级：35.2% vs. 27.6%，P=0.482；≥3 级：7.4% vs. 10.3%，P=0.648）或术后住院时间（中位数：11 天 vs. 10 天，P=0.148）在肌肉减少症和非肌肉减少症患者之间无显著差异。