Pathological analysis of the infiltration of the enucleation plane in stage T1 localized renal cell carcinoma
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摘要: 目的 评估局限性肾癌在肾肿瘤剜除平面的浸润情况，探讨肾肿瘤剜除术良好肿瘤学预后的理论依据。方法 通过对T1期局限性肾癌分别实施后腹腔下根治性肾切除术(RLRN)、后腹腔镜下肾部分切除术(RLPN)及后腹腔镜下肾肿瘤剜除术(RLTE)，在标本离体后进行肿瘤二次剜除以获得剜除标本及瘤床标本，对肾癌假包膜组织构成、特点及肿瘤浸润情况进行病理分析及统计学分析。结果 假包膜出现率为97.01%(65/67)；假包膜平均厚度0.53 mm；假包膜受侵率为86.15%(56/65)；假包膜受侵与肿瘤组织学类型不相关；与T分期及肾透明细胞癌ISUP细胞核分级相关。57例RLRN及RLPN离体标本进行剜除后的瘤床未发现肿瘤侵犯及肿瘤卫星灶。结论 局限性肾癌假包膜受侵概率也较高，但均未超过假包膜，肿瘤假包膜限制了肿瘤对包膜外肾组织的侵犯，并且通过对瘤床病理检测也未发现肿瘤浸润。对T1期局限性肾癌行肾肿瘤剜除术理论上安全、可靠。Abstract: Objective To investigate the invasion of enucleated plane of localized renal cell carcinoma and explore the theoretical prognosis of renal tumor enucleation.Methods Retroperitoneal laparoscopic radical nephrectomy (RLRN), retroperitoneal laparoscopic partial nephrectomy (RLPN) and retroperitoneal laparoscopic tumor enucleation (RLTE) were performed for T1 stage localized renal cell carcinoma. The tumor was reenucleated after the specimens were isolated to obtain enucleated specimens and tumor bed specimens. The characteristics and tumor infiltration were analyzed by pathology and statistics.Results The occurrence rate of pseudocapsule was 97.01% (65/67). The average thickness of pseudocapsule was 0.53 mm. The positive rate of pseudocapsule invasion was 86.2% (56/65). The invasion of pseudocapsule was not related to tumor histological type, while the T stage and renal clear cell carcinoma ISUP classification were found to be related to the invasion. No tumor invasion or tumor satellite foci were found at tumor bed of secondary enucleation specimens of 57 RLRN and RLPN in vitro specimens.Conclusion The invasion rate of pseudocapsule in localized renal cell carcinoma is also high, but it does not beyond the pseudocapsule, which limits the invasion of tumor to the renal tissue outside the capsule, and no tumor infiltration is found through the pathological detection of tumor bed. Enucleation of renal tumor for T1 stage localized renal cell carcinoma is safe and reliable in theory.
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表 1 假包膜受侵情况与肿瘤特点
例 项目 假包膜未受侵 假包膜受侵 Z/χ2 P值 T分期 -1.980 0.048 T1a 8 30 T1b 1 26 ISUP分级 -2.217 0.027 1级 2 2 2级 6 40 3级 0 11 组织学类型 2.540 0.468 透明细胞癌 8 53 嫌色细胞癌 0 1 乳头状细胞癌 1 1 甲状腺滤泡样癌 0 1 
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