目的 探讨直径≥7 cm的肾透明细胞癌(CCRCC)的CT特征在预测Fuhrman分级中的应用价值.方法 回顾性分析经手术病理证实的CCRCC共53例,低级别组(I级与Ⅱ级)共19例,高级别组(Ⅲ级与Ⅳ级)共34例,分析2组的CT特征包括坏死、肾窦受累、形态、侵犯肾静脉、淋巴结转移、假包膜、瘤周血管、瘤体-肾周脂肪囊边界,用x 2检验或Fisher确切概率法分析各CT征象在低级别与高级别组间的差异.结果 高级别组瘤体-肾周脂肪囊分界模糊的发生率高于低级别组(x 2 =6.129,P=0.013),余各项CT征象在高/低级别组之间的差异均无统计学意义(P＞0.05),用瘤体-肾周脂肪囊边界模糊来预测高级别CCRCC,敏感度为61.8％,特异度为73.7％,准确度为66.0％.结论 当瘤体直径≥7 cm时,仅瘤体-肾周脂肪囊边界模糊在预测高级别CCRCC中有一定价值.%Objective To investigate the application value of CT features of clear cell renal cell carcinoma (CCRCC) whose diameter ≥ 7 cm in predicting its Fuhrman grade.Methods 53 patients with CCRCC confirmed by surgery and pathology were analyzed retrospectively,including 19 patients regarded as a low-grade (Grade Ⅰ and Grade Ⅱ) group,and other 34 ones as a high-grade (Grade Ⅲ and Grade Ⅳ) group.The CT features including necrosis,renal sinus involvement,shape,renal vein invasion,lymphnode metastasis,pseudo-capsule,blood vessels around the tumor and the boundary between the tumor and the perirenal fat were analyzed,and the differences in those CT features between two groups were analyzed with chi-square or Fisher exact test.Results The incidence of fuzzy boundary between the tumor and the perirenal fat in the high-grade group was higher than that in the low-grade group (x2 =6.129,P =0.013),however,the differences of the rest CT features between two groups were not statistically significant (P＞0.05).When the fuzzy boundary was used to predict the high-grade CCRCC,the sensitivity,specificity and accuracy was 61.8 ％,73.7 ％ and 66.0 ％,respectively.Conclusion When the diameter of the tumor ≥7 cm,only the fuzzy boundary between the tumor and the perirenal fat has certain value in predicting high-grade CCRCC.
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