【摘要】 目的　肾细胞癌多中心病灶是导致保肾手术后局部复发的主要原因之一。本项研究旨在探讨华人肾细胞癌多中心灶的发病率及相关因素。方法　肾癌根治术标本 10 2例 ,间隔 3mm分层切开 ,检查每个切面 ,原发灶外可疑组织取材镜检 ,确认肾癌者为多中心灶阳性。然后在每个层面 ,假包膜外 15mm的肾组织及肾门组织连续切片镜检确定假包膜完整性、镜下多中心灶 (直径≤ 5mm的多中心灶 )及肾门淋巴结、血管浸润情况。同时评估肾癌多中心性与其它病理指标的关系。结果　本组多中心灶发生率为 15 7% ,原发灶直径≤ 4 0cm组明显低于 4 0cm以上组 (4 9% ,2 / 41vs 2 3 0 % ,14 / 6 1;χ2 =6 0 5 5 ,P =0 0 14 )。无血管浸润组为 9 8% (8/ 82 ) ,明显低于有血管浸润组 (40 0 % ,8/ 2 0 ) ,P =0 0 0 3(Fisher精确概率法 )。假包膜完整组为 1 9% (1/ 5 3) ,明显低于假包膜不完整组 (30 6 % ,15 / 49) (χ2 =15 885 ,P=0 0 0 0 )。原发灶分级、分期、细胞类型及淋巴结浸润与多中心病灶相关性无显著意义 ,Logistic多元回归分析显示血管浸润和包膜不完整是多中心病灶的显著性预测因素 (P值分别为 0 0 0 5 ,0 0 2 3)。结论　本组结果与之前国外的研究报道一致。多中心病灶发生率与原发灶直径、假包膜完整性及血管?更多还原

【Abstract】 Objective To investigate the incidence and associated factors of multicentricity in renal cell carcinoma (RCC) in Chinese patients Methods One hundred and two kidney samples from radical nephrectomy due to RCC were step sectioned at 3 mm intervals and examined All tissue abnormalities were removed, stained and examined for multicentricity Then, on each slice of the sample, both the parenchymal margin of 15 mm beyond the pseudocapsule and tissue around the renal sinus were continuously sectioned and examined for completeness of the pseudocapsule and vascular and lymph node invasion The relationship between muliticentricity and other pathological parameters was evaluated Results The incidence of multicentricity was 15 7% (16/102); it was significantly lower in primary tumors ≤4 0 cm than in tumors >4 0 cm (4 9%, 2/41 vs 23 0%, 14/61; χ 2=6 055, P =0 014) The incidence was 9 8% (8/82) in tumors without vascular invasion and 40 0% (8/20) in those with it ( P =0 003, Fisher’s exact test) The incidence of multicentricity was 1 9% (1/53) in tumors with a complete pseudocapsule and 30 6% (15/49) in those without it (χ 2=15 885, P =0 000) The grade, stage, subtypes and lymph node invasion of the primary tumor were not significantly associated with multicentricity Multiple logistic regression analysis showed that pseudocapsular incompleteness and vascular invasion were two significant predictors of RCC multicentricity ( P =0 005 and 0 023) Conclusions The incidence of multicentricity of RCC in this group of patients was in accordance with published studies Multifocality was significantly associated with tumor size, pseudocapsule completeness and vascular invasion NSS should be limited to tumors less than 4 0 cm when the contralateral kidney is normal and careful long term follow up is necessary in tumors with positive vascular invasion and incomplete pseudocapsule更多还原