肾细胞癌副肿瘤综合征的临床特点及其预后Clinical Features and Prognosis of Paraneoplastic Syndromes in Renal Malignancies
杨瑜;毛全宗;李汉忠;纪志刚;严维刚;荣石;刘广华;徐维锋;肖河;王惠君;
YANG Yu,MAO Quan-zong,LI Han-zhong,JI Zhi-gang,YAN Wei-gang, RONG Shi,LIU Guang-hua,XU Wei-feng,XIAO He,WANG Hui-jun Department of Urology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College,Beijing 100730,China
摘要(Abstract):
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5.5cm,其余患者肿瘤平均直径为4.7cm,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。
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.
关键词(KeyWords):
副肿瘤综合征;肾细胞癌;预后
paraneoplastic syndrome;renal cell carcinoma;prognosis
基金项目(Foundation):
作者(Author):
杨瑜;毛全宗;李汉忠;纪志刚;严维刚;荣石;刘广华;徐维锋;肖河;王惠君;
YANG Yu,MAO Quan-zong,LI Han-zhong,JI Zhi-gang,YAN Wei-gang, RONG Shi,LIU Guang-hua,XU Wei-feng,XIAO He,WANG Hui-jun Department of Urology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College,Beijing 100730,China
Email:
DOI:
参考文献(References):
- [1]Sacco E,Pinto F,Sasso F,et al.Paraneoplastic syndromes in patients with urological malignancies[J].Urol Int,2009,83:1-11.
- [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.
- [3]Motzer RJ,Mazumdar M,Bacik J,et al.Survival and prog-nostic stratification of670patients with advanced renal cell carcinoma[J].J Clin Oncol,1999,17:2530-2540.
- [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.
- [5]Ding GX,Song NH,Feng CC,et al.Is there an association between advanced stage of renal cell carcinoma and paraneo-plastic syndrome[J].Med Princ Pract,2012Jan6.[Epub ahead of print]DOI.10:1159/000334873.
- [6]Wiesener MS,Seyfarth M,Warnecke C,et al.Paraneo-plastic erythrocytosis associated with an inactivating point mutation of the von Hippel-Lindau gene in a renal cell carci-noma[J].Blood,2002,99:3562-3565.
- [7]Michael A,Politi E,Havranek E,et al.Prognostic significance of erythropoietin expression in human renal cell carci-noma[J].BJU Int,2007,100:291-294.
- [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.
- [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.
- [10]Donmez T,Kale M,Ozyurek Y,et al.Erythrocyte sedi-mentation rates in patients with renal cell carcinoma[J].Eur Urol,1992,21Suppl1:51-52.
- [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.
- [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 co-ma:a case report and review of the literature[J].J Gen Intern Med,2007,22:1042-1046.
- [14]Chasan SA,Pothel LR,Huben RP.Management and prognostic significance of hypercalcemia in renal cell carcinoma[J].Urology,1989,33:167-170.
- 杨瑜
- 毛全宗
- 李汉忠
- 纪志刚
- 严维刚
- 荣石
- 刘广华
- 徐维锋
- 肖河
- 王惠君
YANG Yu- MAO Quan-zong
- LI Han-zhong
- JI Zhi-gang
- YAN Wei-gang
- RONG Shi
- LIU Guang-hua
- XU Wei-feng
- XIAO He
- WANG Hui-jun Department of Urology
- Peking Union Medical College Hospital
- Chinese Academy of Medical Sciences & Peking Union Medical College
- Beijing 100730
- China
- 杨瑜
- 毛全宗
- 李汉忠
- 纪志刚
- 严维刚
- 荣石
- 刘广华
- 徐维锋
- 肖河
- 王惠君
YANG Yu- MAO Quan-zong
- LI Han-zhong
- JI Zhi-gang
- YAN Wei-gang
- RONG Shi
- LIU Guang-hua
- XU Wei-feng
- XIAO He
- WANG Hui-jun Department of Urology
- Peking Union Medical College Hospital
- Chinese Academy of Medical Sciences & Peking Union Medical College
- Beijing 100730
- China