ДВУСТОРОННИЙ АСИНХРОННЫЙ РАК ПОЧЕК

Among 1430 patients with renal tumors, followed up at the Urology Clinic, I. M. Sechenov Moscow Medical Academy, in 1973 to 2007, 117 (8.2%) patients were found to have bilateral neoplasms, 81 (5.7%) patients being diagnosed as having bilateral renal cell carcinoma (RCC), out of them 51 (3.6%) and 30 (2.1%) patients had synchronous and asynchronous RCC, respectively. Asynchronous tumor was identified in 19 (63.3%) and 8 (26.7%) patients in the period of under 5 and >10 years (including 22 years in 1 case), respectively, after initial tumor removal. Among 30 patients with asynchronous RCC, 27 had previously undergone nephrectomy and 3 had resection of a kidney with tumor. When asynchronous RCC was detected, its treatment policy consisted of organ-preserving surgery. Analysis of the morphological pattern of a tumor in patients with bilateral asynchronous RCC revealed its similar type in 85.2% of cases and the identical degree of tumor cell differentiation in 48.1%; the patients with a varying degree of differentiation were ascertained to have high-grade asynchronous malignancy in 92.9% of cases. Molecular genetic studies showed that all the patients had mutations of VHL and FHIT genes located on the third pair of chromosomes. Our findings indicate that bilateral RCC is a genetically determined primarily bilateral tumor process that can manifest itself at once (synchronously) or after a (frequently considerable) time (asynchronously). In asynchronous carcinoma, overall and adjusted 5-year survival rates were 53.3 and 60%, respectively. The fact that an asynchronous tumor may occur in the contralateral kidney a considerable time after the first surgery necessitates to make a regular purposeful follow-up of patients operated on for unilateral RCC. The minimum control examination should include chest X-ray study, ultrasonography of the remaining kidney, removed tumor bed, and great vessels, which should be performed every 6 months within the first 5 years, then once every year. If a disease relapse is suspected, multispiral computed tomography of the abdomen and retroperitoneal space is to be made.