-
摘要:
目的 探讨肾脏恶性肿瘤伴发副肿瘤综合征的临床特点及其与预后的关系。 方法 回顾性分析北京协和医院2008年1月至2009年12月464例经手术和病理确诊的肾细胞癌患者的临床资料及其随访结果。 结果 464例肾细胞癌患者中伴发副肿瘤综合征156例(33.6%), 主要临床表现为贫血(26.3%, 41/156)、高血压(24.4%, 38/156)、发热(21.8%, 34/156)、红细胞增多症(19.2%, 30/156)、Stauffer综合征(17.3%, 27/156)、食欲不振、乏力、体重减轻(15.4%, 24/156)、血沉加快(12.8%, 20/156)、白细胞增多症(8.3%, 13/156)、高钙血症(5.1%, 8/156)、糖代谢紊乱(1.9%, 3/156)、性激素异常(0.6%, 1/156)等。156例伴发副肿瘤综合征患者的肿瘤平均直径为5.5 cm, 其余患者肿瘤平均直径为4.7 cm, 两者比较差异有统计学意义(P < 0.01)。 结论 肾脏恶性肿瘤副肿瘤综合征的发生率约为33.6%, 其出现与肿瘤分期有相关性。 Abstract:Objective To investigate the clinical features and prognosis of paraneoplastic syndromes (PNS) in patients with renal carcinoma. Methods The clinical data and follow-up results of 464 patients with surgically and pathologically confirmed renal cell carcinoma (RCC) were retrospectively reviewed. Results Of these RCC cases, PNS was identified in 156 patients (33.6%) and manifested as anemia (26.3%, 41/156), hypertension (24.4%, 38/156), fever (21.8%, 34/156), polycythemia (19.2%, 30/156), Stauffer's syndrome (17.3%, 27/156), fatigue, weight loss, and anorexia (15.4%, 24/156), high erythrocyte sedimentation rate (12.8%, 20/156), leukocytosis (8.3%, 13/156), hypercalcemia (5.1%, 8/156). The average diameter of tumors was 5.5 cm in these 156 patients and was 4.7 cm in the remaining patients (P < 0.01). Conclusion The incidence of RCC is about 33.6% in patients with renal carcinoma, and the morbidity may be associated with the tumor stages. -
Key words:
- paraneoplastic syndrome /
- renal cell carcinoma /
- prognosis
-
表 1 肾细胞癌伴发副肿瘤综合征患者临床表现及其结局
临床表现 病例
[n (%) ]性别
(男/女)平均年龄
(岁)肿瘤分期 临床指标 术前 术后 贫血 41 (26. 3) 32: 9 65. 5 T2a-T4N0-N2M0-M1 血红蛋白男平均103 g /L,女
平均97 g /L32例1个月正常,9例较
术前提高3 g /L高血压 38 (24. 4) 27:11 59. 2 T1a-T4N0-N1M0 血压平均165 /90 mm Hg 23例3个月正常,余6
个月收缩压下降20 mm Hg发热 34 (21. 8) 28: 6 51. 7 T1a-T3N0M0-M1 体温平均38. 5℃ 正常 红细胞增多症 30 (19. 2) 25: 5 53. 0 T1b-T4N0-N1M0-M1 血红蛋白167 g /L 25例1周内正常,5例6
个月正常Stauffer综合征 27 (17. 3) 23: 4 61. 8 T1a-T4N0-N2M0-M1 14例ALT升高,4例AST升高,
7例GT升高,3例AKP升高,5
例胆红素升高,11例Alb升高23例正常,4例6个月正
常食欲不振、乏力、体重减轻 24 (15. 4) 18: 6 58. 5 T3a-T4N0-N2M0-M1 体重平均3个月下降3 ~ 4 kg 改善明显,5例6个月内
发生转移血沉加快 20 (12. 8) 14: 6 63. 0 T1a-T4N0M0-M1 血沉44. 9 mm /min 正常 白细胞增多症 13 (8. 3) 9: 4 57. 7 T1a-T4N0-N1M0-M1 白细胞15. 22 × 109 /L 1个月正常 高钙血症 8 (5. 1) 6: 2 45. 2 T2b-T4N0-N1M0-M1 血钙3. 25 mmol /L 6例正常; 2例改变不明
显,6个月内发生肺转移糖代谢紊乱 3 (1. 9) 男 61. 0 T1a-T 3bN0M0 血糖8. 7 mmol /L 正常 性激素异常 1 (0. 6) 男 44. 0 T1aN0M0 雌二醇升高,睾酮降低 正常 ALT:丙氨酸转氨酶; AST:天门冬氨酸氨基转移酶; GT: γ-谷氨酰转移酶; AKP:碱性磷酸酶; Alb:白蛋白 -
[1] Sacco E, Pinto F, Sasso F, et al. Paraneoplastic syndromes in patients with urological malignancies[J]. Urol Int, 2009, 83:1-11. doi: 10.1159/000224860 [2] Kirkali Z, Esen AA, Kirkali G, et al. Ferritin:a tumor marker expressed by renal cell carcinoma[J]. Eur Urol, 1995, 28:131-134. doi: 10.1159/000475037 [3] Motzer RJ, Mazumdar M, Bacik J, et al. Survival and prognostic stratification of 670 patients with advanced renal cell carcinoma[J]. J Clin Oncol, 1999, 17:2530-2540. doi: 10.1200/JCO.1999.17.8.2530 [4] Zucchetto A, Dal Maso L, Tavani A, et al. History of treated hypertension and diabetes mellitus and risk of renal cell cancer[J]. Ann Oncol, 2007, 18:596-600. doi: 10.1093/annonc/mdl438 [5] Ding GX, Song NH, Feng CC, et al. Is there an association between advanced stage of renal cell carcinoma and paraneoplastic syndrome?[J]. Med Princ Pract, 2012 Jan 6.[Epub ahead of print] DOI. 10: 1159/000334873. [6] Wiesener MS, Seyfarth M, Warnecke C, et al. Paraneoplastic erythrocytosis associated with an inactivating point mutation of the von Hippel-Lindau gene in a renal cell carcinoma[J]. Blood, 2002, 99:3562-3565. doi: 10.1182/blood.V99.10.3562 [7] Michael A, Politi E, Havranek E, et al. Prognostic significance of erythropoietin expression in human renal cell carcinoma[J]. BJU Int, 2007, 100:291-294. doi: 10.1111/j.1464-410X.2007.06978.x [8] 高旭, 任善成, 侯建国, 等. Stauffer综合征44例报告[J].中华泌尿外科杂, 2009, 30:735-737. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zhmnwk200911004 [9] Kim HL, Belldegrun AS, Freitas DG, et al. Paraneoplastic signs and symptoms of renal cell carcinoma:implications for prognosis[J]. J Urol, 2003, 170:1742-1746. doi: 10.1097/01.ju.0000092764.81308.6a [10] Donmez T, Kale M, Ozyurek Y, et al. Erythrocyte sedimentation rates in patients with renal cell carcinoma[J]. Eur Urol, 1992, 21 Suppl 1:51-52. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=1706a36729e303a04847813d74e3aa28 [11] Kawai Y, Matsuyama H, Korenaga Y, et al. Preoperative erythrocyte sedimentation rate is an independent prognostic factor in Japanese patients with localized clear cell renal cell carcinoma[J]. Urol Int, 2009, 83:306-310. doi: 10.1159/000241673 [12] Filgreira PHOF, Vasconcelos LF, Jnior GBS, et al. Paraneo; oastic syndromes and the kedney[J]. Saudi J Kidney Dis Transpl, 2010, 21:222-231. [13] Pepper K, Jaowattana U, Starsiak MD, et al. Renal cell carcinoma presenting with paraneoplastic hypercalcemic coma:a case report and review of the literature[J]. J Gen Intern Med, 2007, 22:1042-1046. doi: 10.1007/s11606-007-0189-1 [14] Chasan SA, Pothel LR, Huben RP. Management and prognostic significance of hypercalcemia in renal cell carcinoma[J]. Urology, 1989, 33:167-170. doi: 10.1016/0090-4295(89)90383-X
计量
- 文章访问数: 149
- HTML全文浏览量: 46
- PDF下载量: 5
- 被引次数: 0