摘要目的：研究与比较肾肉瘤样癌（Sarcomatoid renal cell carcinoma，SRCC）与肾透明细胞癌（Clear cell renal cell carcinoma，CCRCC）在同步转移方式上的不同，以利于临床鉴别诊断。方法：同步转移是指诊断时出现的转移， 回顾性分析直径＞6 cm的45例SRCC与143例CCRCC的病例及影像学资料，所有病例均行术前腹部增强CT检查，采用χ2检验或Fisher确切概率法对两者同步转移部位进行分析。结果：16例SRCC和10例CCRCC出现同步转移（16/45 vs 10/143），11例SRCC和1例CCRCC出现同步淋巴结转移（11/45 vs 1/143），6例SRCC与6例CCRCC出现肺转移（6/45 vs 6/143），6例SRCC和1例CCRCC出现同步多部位转移（6/45 vs 1/143），差异均具有统计学意义（P值依次为0.000，0.000，0.039，0.003）。然而，将以上3个特征纳入Logistic回归分析后，仅同步淋巴结转移有统计学意义（P=0.030）。结论：同步淋巴结转移在SRCC中比CCRCC中更常见，有助于鉴别SRCC与CCRCC。
Abstract：Objective: To investigate and compare the synchronous metastasis distribution of sarcomatoid renal cell carcinoma(SRCC) and clear cell renal cell carcinoma(CCRCC), so as to contribute to their differential diagnosis. Methods: Synchronous metastasis means metastasis at the time of diagnosis. A retrospective analysis of the medical records and imaging data of 45 SRCC and 143 CCRCC which diameter larger than 6 cm, all the cases had their preoperative abdominal enhancement CT, analysis their synchronous metastasis distribution by χ2 or Fisher’s exact test. Results: There were 16 SRCC and 10 CCRCC had synchronous metastasis(16/45 vs 10/143), 11 SRCC and 1 CCRCC had synchronous lymph node metastasis(11/45 vs 1/143), 6 SRCC and 6 CCRCC had synchronous lung metastasis(6/45 vs 6/143), 6 SRCC and 1 CCRCC had multiple synchronous metastasis(5/45 vs 1/143), and the differences were statistically significant(P=0.000, 0.000, 0.039, 0.003). However, only synchronous lymph node metastasis remained statistically significant(P=0.030) by Logistic regression. Conclusion: Synchronous lymph node metastasis can help to discriminate SRCC and CCRCC, as this feature is more common in SRCC.
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