上海市浦东新区居民肾癌患者生存率影响因素分析

Analysis on factors associated with the survival rate of the patients with sporadic renal carcinoma in Pudong new area

目的：分析影响肾癌患者总体生存率相关危险因素，为肾癌防治和预测肾癌患者预后提供参考依据。方法：应用Kaplan—Meier法、Log—rank检验和Cox多元回归模型分析上海市浦东新区1991例肾癌患者年龄、性别、职业、居住地、就诊医院水平、肿瘤TNM分期、癌情告知情况和手术情况与患者总体生存率的关系。结果：1991例肾癌患者平均生存期为47．64个月，中位生存期为154个月。不同因素患者组中位生存期比较，没有选择手术的患者组为13个月，低于选择手术患者组的228个月，x2=661．330，P〈0．001；TNM高分期组患者为20个月，低于TNM低分期的患者组227个月，x2=389．780，P〈O．001；癌情隐瞒组为135个月，低于癌情告知组227个月，x2=24．834，P〈O．001；在一、二级医院诊疗的患者为56个月，低于在三级医院诊疗患者的312个月，x2=164．653，P％0．001；肾癌患者的总体生存率与性别、职业、居住地等差异无统计学意义，P〉O．05；多因素Cox回归模型分析结果表明，隐瞒患者肿瘤情况（RR=1．982，95％cI：1．373～2．863，P〈O．001）、在低等级医院诊疗（RR=1．947，95％CI：1．356～2．797，P〈0．001）、肿瘤TNM高分期（RR=7．662，95％CI：5．243～11．198，P〈0．001）和没有选择手术治疗（RR=2．447，95％CI：1．629～3．676，P〈0．001）是肾癌总体生存率降低的独立危险因素。结论：争取肿瘤早发现，尽量选择高水平的医院并进行手术治疗和尊重肾癌患者的知情权是提高肾癌患者生存期的有效措施。

OBJECTIVE： To explore the risk factors of the survival of patients with renal cell carcinoma （RCC） for providing a reference for the prevention and predicting the patient＇s prognosis. METHODS： According to Cancer Repor ting System in Pudong new area, subsets of 1 991 RCC patients were used to screen the potential risk factors, such as cancer awareness, age, TNM stage,occupation, gender, residential areas and the level of therapeutic hospital The patient＇s survival in different groups was analyzed by Kaplan-Meier method,Log-rank test and Cox regression analysis. RESULTS： In the 1 991 RCC patients, the average survival time was 47.64 months and the median survival time was 154 months. Comparing with the different group＇s median survival time, the survival time for patients without surgery were 13 months which was lower than the 228 months of those with surgery（x2 =661. 330,P〈0. 001）. The patients with [11 or IV stage were 20 months,lower than the 227 months of those with I or lI stage（x2 = 389. 780, P〈0. 001）. The patients who were concealed the information of suffering cancer were 135months, lower than the 227 months of those with cancer awareness（x2= 24. 834,P〈0. 001）, and the patients treated by the hospitals with low level were 56 months, lower than the 312 months of those treated in the high level hospitals（x2= 164. 653 ,P〈0. 001）. There was no statistical significance in gender, occupation, residential areas （ x2 were 0. 216,2. 625 and 1.450, respectively, all P 〈 0.05 ）. Cox multivariate re- gression analysis showed that being concealed cancer information（RR= 1. 982,95 CI= 1. 373-- 2. 863 ,P〈0. 001）, lower level of therapeutic hospital（RR= I. 947,95 % CI = I. 356 -- 2. 797, P〈0. 001 ）, without surgical treatment（RR= 2. 447, 95%CI=1.629--3.676,P〈0.001） and late-stage tumor （RR=7.662,95% CI=5.243--11.198,P〈0.001） were inde- pendent risk factors associated with cancer-related death. CONCLUSION： Detection of early cancer, respect for the patientsright,and suitable surgical treatment are effective measures to improve survival in patients with RCC.