Clinical Characteristics,Diagnosis And Treatment Of Grade 4 Clear Cell Renal Cell Carcinoma

Objective:To investigate the clinical epidemiological features,symptoms,stages,imaging features,pathological features,treatment and prognosis of grade 4 clear cell renal cell carcinoma,so as to provide clinical basis for the diagnosis and treatment of grade 4clear cell renal cell carcinoma.Methods:We retrospectively analyzed the clinical data of 32 patients with grade 4 clear cell renal cell carcinoma confirmed by pathology in our hospital from December 2013 to May 2019,and the clinical epidemiological features,symptoms,stages,imaging features,pathological features,treatment and prognosis of grade 4 renal clear cell carcinoma were analyzed.RESULTS:Among the 32 patients,9 cases(28.1%)were admitted because of renal tumor found by physical examination,11 cases(34.3%)were admitted for low back pain,9cases(28.1%)were admitted for gross hematuria,2 cases(6.2%)were admitted for fever,and 1 case(3.1%)was admitted for thrombocytopenia.All the tumors were unilateral,of which 23 cases(71.8%)were located in the left kidney and 9 cases(28.2%)in the right kidney;the maximum diameter of the tumor ranged from 2.5cm to 10.7cm,averaging(6.9±2.3cm).Preoperative imaging examination: enhanced CT scan of 17 patients(53.1%)showed that the enhancement degree of tumor in cortical phase was lower than that of renal parenchyma,14 patients(43.7%)showed tumor with varying degrees of bleeding and necrosis,6 cases(18.7%)showed retroperitoneal or renal hilar lymph node metastasis,2 cases(6.2%)showed multiple pulmonary metastasis,and 2 cases(6.2%)showed renal vein tumor thrombus.Of the32 cases,24 cases(75%)underwent retroperitoneal laparoscopic radical nephrectomy and 8 cases(25%)underwent retroperitoneal laparoscopic partial nephrectomy.among them,2 cases of retroperitoneal laparoscopic radical nephrectomy and 1 caseof retroperitoneal laparoscopic partial nephrectomy were converted to open surgery because of severe adhesion between tumor and surrounding tissues.All the 32 patients were pathologically diagnosed as grade 4 clear cell renal cell carcinoma,of which 5 cases(15.6%)were associated with sarcomatoid differentiation.Postoperative staging: 9 cases of stage I(28.1%),II stage 14 cases(43.7%),II stage 5cases)(15.6%),IV stage 4 cases(12.5%).All the 32 patients received complete follow-up after operation.the follow-up period ranged from 10 months to 30 months,with an average of(20.2±4.4 months).Distant metastasis occurred in 2 cases,and no obvious signs of recurrence or metastasis were found in the rest of the patients.Conclusions:The clinical manifestations of patients with grade 4 clear cell renal cell carcinoma had slightly larger tumor volume and earlier clinical manifestations than patients with lower grade ccRCC patients.The diagnosis mainly depended on postoperative pathology and preoperative operation,and the clinical treatment effect was poor.According to the clinical features and imaging findings,the pathological classification of ccRCC patients can be inferred,so as to adopt individualized treatment plans for different patients,which may be more beneficial to the prognosis of ccRCC patients of grade 4.