|
Objective To investigate the clinical form of kidney cancer trends; summary kidney cancer diagnosis, treatment evolution; explore how to prevention and early detection, treatment kidney cancer: How to improve the prognosis of survival. Materials and Methods Urology, Shandong Provincial Hospital from January 1993 to January 2008 a total of 16,216 cases of hospitalized patients. Inclusion criteria: Urology hospital from January 1993 to January 2008 were treated 483 cases of kidney cancer data (age, sex, clinical manifestations, laboratory examinations, treatment, pathological type, follow-up). Will be divided into three periods of 15 years: 90 years (93 years -98 years), in the late 1990s (98 -03 years), the beginning of the century (2003 -08). Applications average composition ratio, median, rate the various indicators were statistically analyzed. Results: The 1990s, the late 1990s and early this century, the average annual number of admissions were 475.2,796.8,1971.2; annual RCC were 2.35% hospitalization rate, 2.76%, 3.25%. In the mid-1990s, mainly in the age of onset 41-50 years; late 1990s, most concentrated in 45-55 years, the proportion of patients aged over 60 increased; beginning of this century, with the highest concentration of 60-70 years the proportion of patients over 60 years old continue to increase. Clinical manifestations: hematuria 177 cases (36.6%), of which 45 cases of microscopic hematuria: low back pain or abdominal pain in 89 cases (18.4%); abdominal mass in 44 cases (9.11%); \Renal manifestations: hypertension 59 cases (12.2%); fever 44 cases (9.1%); anemia in 43 cases (8.9%); emaciation 40 cases (8.3%). Laboratory examinations: preoperatively by B-ultrasound, suggesting kidney 471 cases (97.5%), 8 cases of inferior vena cava tumor thrombus prompt diagnosis of renal angiomyolipoma 7 cases; 383 routine CT scan, suggesting that 377 cases of renal cell carcinoma ( 98.4%, in which the tumor diameter <3cm of small renal cell carcinoma 87 cases), the diagnosis. Renal angiomyolipoma three cases; IVU KUB examination 161 cases, including 125 cases of renal contour display changes, renal pelvis pressure, does not develop other changes, 36 cases showed no abnormalities, diagnostic accuracy was 77.6%. Chest radiographs prompt lung metastasis in 13 cases. 8 cases of inferior vena cava tumor thrombus in patients underwent MRI. Treatment: OK radical nephrectomy surgery 332 cases, nonstandard radical resection of renal cell carcinoma, 56 cases of kidney nephron sparing surgery (partial nephrectomy or tumor wedge resection) in 14 cases, exploratory surgery (tumor unresectable), 36 cases of renal artery embolization in 13 cases, 45 patients without surgery (35 cases in which the patient to give up, 17 cases of inadequate funding, medical reasons untreated 13 cases). Adjuvant chemotherapy in 92 patients, radiotherapy in 47 cases, 176 cases of interferon therapy; interferon treatment 73 cases in which chemotherapy, radiotherapy interferon treatment 22 cases. 483 cases of patients who died during hospitalization without one case, local tumor recurrence and (or) transfer of reoperation in 13 cases. Pathological types: clear cell carcinoma group totaled 392 cases, accounting for 89.50%, clear cell carcinoma of the decade the number of cases tended to increase with the years; addicted chromophobe cell carcinoma (papillary renal cell carcinoma) group of 26 cases, accounting for 5.38% ; chromophobe renal cell carcinoma, 5 cases (1.03%), other types of 19 cases (3.93%). Tumor grade: G1 96 例, G2 196 例, G3 52 cases, 139 cases of unrated. Prognosis: Treatment of patients with 483 cases in 322 patients were followed for an average follow-up time was 73.6 months (6 months to 13 years). Surgery three years, five years, 10-year survival rates were 72.7% (157/216), 52.5% (67/139), 19.1% (8/42). 96 cases of sporadic renal cell carcinoma patients after 3 years, 5 years, 10-year survival rates were 78.2% (61/78), 61.9% (26/42), 38.5% (5/13). Continue treatment after discharge of patients accounted for 37.2%; conduct periodic review of 65 persons. Conclusion: With the development of the times, the average annual number of hospitalizations increased gradually increased significantly since the late 1990s: the average annual rate of hospitalization in patients with renal cell carcinoma have increased year by year; kidney increasing age at onset of aging trend. Clinical manifestations of renal cell carcinoma: past the so-called RCC \B ultrasound diagnosis of renal cell carcinoma with high accuracy, the patient had no pain, and inexpensive, is the preferred diagnostic method, while CT in tumor localization, diagnosis rate is higher than B-, is the most reliable diagnostic tool. Surgery is the main method of treatment of renal cell carcinoma, surgical options specific decisions according to the disease, radical nephrectomy kidney cancer is still the most effective method of treatment. Biological agents or adjuvant radiotherapy can improve survival prognosis, single chemotherapy ineffective. Currently discharged after the review, the situation improved than before treatment, doctors need to further strengthen the treatment of kidney cancer and follow-up of knowledge and meaning propaganda.
|