Clinical Features And Prognosis Of Renal Malignant Mesenchymal Tumors

Objective: To explore the clinical features,pathological features,surgical treatment and prognostic factors of renal mesenchymal malignancy.Methods: Retrospective analysis was performed on the clinical data of 50 patients with renal mesenchymal malignancies admitted to the First Affiliated Hospital of Xinjiang Medical University from January2005 to June 2019,their age ranged from 16 ～ 79 years,including 30 males and 20 females.The patients who first complained of lumbago were 32 cases,8 cases of bloating and 2 cases of blood urine.And one case was seen in orthopedics due to upper arm pain,and the patient’s completion of the examination indicated a tumor of kidney origin.Urinary ultrasound and CT examination were completed in all patients.CT examination mostly showed renal space-occupying lesions,and some tumors may have liquefaction,necrosis or cystic changes.After enhancement,the tumor was irregularly enhanced,with unclear edges,which was difficult to distinguish from renal carcinoma.Clinical staging was conducted according to the imaging results at the time of initial diagnosis.All patients were followed up,and 2 of them were lost to follow-up.Among the 48 patients who were followed up,17(18/48)underwent radical nephrectomy,22(22/48)underwent partial nephrectomy,and 9(9/48)did not receive surgical treatment.The related factors were analyzed univariate by Kaplan-Meier method,and the difference in cumulative survival rate was tested by Log-rank method.The significant variables were introduced into COX risk regression model for multi-factor analysis,and the survival curve was plotted by Kaplan-Meier method.The difference was statistically significant when P≤0.05.Results: Among the 48 patients who were followed up,7 were in clinical Stage T1,16 were in Stage T2,20 were in stage T3,and 5 were in stage T4.Conventional pathology and immunohistochemistry confirmed 17 cases(17/48)as leiomyosarcoma,17 cases(17/48)as liposarcoma,and 14 cases as other types of mesenchymal malignancies.17 cases(17/48)underwent radical nephrectomy,22 cases(22/48)underwent partial nephrectomy,and 9 cases(9/48)did not receive surgical treatment.The 5-year cumulative survival rate of patients with normal prothrombin time(36.8%)was higher than that of patients with abnormal prothrombin time(11%),and the difference was statistically significant(P < 0.05).The 5-year cumulative survival rate of liposarcoma patients(30.8%)was higher than that of leiomyosarcoma patients(18.2%),and the difference was statistically significant(P < 0.05).The 5-year cumulative survival rate of patients underwent radical surgery(44.6%)was higher than that of patients undergoing partial nephectomy(29.8%),with statistically significant difference(P < 0.05).Conclusions: Renal mesenchymal malignant tumor is rare,and highly malignant.Patients with Renal liposarcoma lives longer than other types of tumors.Preoperative puncture biopsy of renal mesenchymal malignant tumor does not affect patient’s prognosis.Patients with abnormal prothrombin time have a poor prognosis.And the earlier the clinical stage at the first diagnosis,the better the prognosis.Combining imaging examinations and needle biopsy to confirm early diagnosis and timely selection of radical surgery can improve the survival time of patients.