Tian Y, Cheng X Y, He H Y, Wang G L, Ma L L
Department of Urology, Peking University Third Hospital, Beijing 100191, China.
Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2021 Oct 18;53(5):928-932. doi: 10.19723/j.issn.1671-167X.2021.05.019.
To investigate the clinical characteristics, diagnosis and treatment of renal cell carcinoma with urinary tract tumor thrombus.
From January 1, 2015 to December 31, 2019, patients with renal cell carcinoma complicated with urinary tract tumor thrombus who were hospitalized in the Peking University Third Hospital and Beijing Friendship Hospital, Capital Medical University were retrospectively analyzed. Meanwhile, we reviewed the literature, and the reported patients of renal cell carcinoma with urinary tract tumor thrombus were also included in our study. The basic information, clinical manifestations, treatment, pathological characteristics and follow-ups of all the patients were analyzed.
In our study, 6 patients from the two hospitals and 16 patients from previous literature reports were included. There were 13 males and 9 females with an average age of 54.7 years (22-79 years). Fifteen patients had renal cell carcinoma on the left side, 6 on the right side, and 1 on the unknown side. Gross hematuria was the most common chief complaint, including 18 patients. One patient complained of weight loss, 1 patient complained of microscopic hematuria, and 1 patient was found by ultrasound examination. Tumor thrombus was classified as grade Ⅰ in 9 cases (the tumor embolus protruded into the renal pelvis, but did not reach the ureteropelvic junction), grade Ⅱ in 10 cases (the tumor embolus protruded into the ureter, but not into the bladder), and grade Ⅲ in 3 cases (the tumor embolus passed through the ureter and protruded into the bladder). Only 11 patients were diagnosed with renal cell carcinoma before operation. Radical nephrectomy was performed in 9 cases and nephroureterectomy in 12 cases. In pathological diagnosis, there were 15 cases of clear cell renal cell carcinoma, 1 case of papillary renal cell carcinoma, 1 case of chromophobe cell carcinoma, 1 case of mixed cell renal cell carcinoma, 4 cases of renal cell carcinoma with undetermined classification. Eleven patients were followed up for 3-31 months, and 3 patients had lung metastasis within 6 months.
Renal cell carcinoma with urinary tract tumor thrombus is rare in clinic. It needs to be differentiated from renal pelvis carcinoma in diagnosis. The treatment principle can refer to general renal carcinoma. For locally advanced cases, complete resection is the best treatment, and its oncological prognosis needs more long-term and large-scale follow-up observation.
探讨肾细胞癌合并尿路肿瘤血栓的临床特点、诊断及治疗方法。
回顾性分析2015年1月1日至2019年12月31日在北京大学第三医院和首都医科大学附属北京友谊医院住院的肾细胞癌合并尿路肿瘤血栓患者。同时查阅文献，将已报道的肾细胞癌合并尿路肿瘤血栓患者纳入本研究。分析所有患者的基本信息、临床表现、治疗方法、病理特征及随访情况。
本研究纳入两家医院的6例患者及既往文献报道的16例患者。其中男性13例，女性9例，平均年龄54.7岁（22 - 79岁）。左侧肾细胞癌15例，右侧6例，1例部位不明。最常见的主诉是肉眼血尿，共18例。1例主诉体重减轻，1例主诉镜下血尿，1例经超声检查发现。肿瘤血栓分级：Ⅰ级9例（肿瘤栓子突入肾盂，但未达输尿管肾盂连接处），Ⅱ级10例（肿瘤栓子突入输尿管，但未进入膀胱），Ⅲ级3例（肿瘤栓子通过输尿管并突入膀胱）。术前仅11例诊断为肾细胞癌。9例行根治性肾切除术，12例行肾输尿管切除术。病理诊断：透明细胞肾细胞癌15例，乳头状肾细胞癌1例，嫌色细胞癌1例，混合细胞肾细胞癌1例，未定型肾细胞癌4例。11例患者随访3 - 31个月，3例在6个月内发生肺转移。
肾细胞癌合并尿路肿瘤血栓临床少见，诊断时需与肾盂癌相鉴别，治疗原则可参照一般肾癌。对于局部进展病例，完整切除是最佳治疗方法，其肿瘤学预后需要更多长期、大规模的随访观察。
