影响肾癌根治术后病人生存率的因素分析

目的探讨影响肾癌根治术后病人预后的因素。方法对1990年1月-2006年12月收治并采用“肾癌根治术”治疗的肾细胞癌患者359例进行随访。将所有资料编码后建立数据库，经校对无误后输入SPSS12．0统计包。采用寿命表法计算总体生存率，采用Cox回归模型比较多种因素对生存时间的影响。所有统计描述及统计分析均在SPSS12．0统计包上进行，以P〈0．05为统计学上差异有显著性意义。结果按病理分型：透明细胞癌264例，颗粒细胞癌43例，混合细胞癌29例，其他（嫌色细胞癌、肉瘤样肾癌等）23例。按TNM分期：T1N0M0 197例，T2N0M0 118例，T2N2M0 6例，T3N0M0 5例，T3N1M0 8例，T3N2M03例，T3N0M1 22例。220例获得随访。一年生存率为84．47±2．45％，三年生存率为73．26±3．28％，五年生存率为65．21±4．29％，十年生存率为55．18±7．47％。结论“性别”、“合并瘤栓”、“TNM”、“Robson”、“后期治疗”对肾癌根治术后病人预后的影响有显著意义（P〈0．05）；而“年龄”、“三联征”、“病程”、“侧别”、“合并内科病”、“手术入路”、“手术方式”对肾癌根治术后病人预后的影响无显著意义（P〉0．05）。

Objective To study the factors which affect the prognosis of radical nephrectomy. Methods 359 cases of renal cell carcinoma treated with ＂Radical Nephrectomy＂ from Jan. 1990 to Dec 2006 were reviewed. All the data were input to Excel database after they were encoded, and then read by SPSS 12.0 statistic software. The cumulative survival rates were calculated by the life - table method. We assess the impact of multiple covariates in survival time with Cox Regression model. Statistical analysis were done with the SPSS 12.0 statistic software. All tests were performed at the 0.05 level of significances. Results The pathological results showed that 264 cases were clear cell carcinoma, 43 cases being granular cell carcinoma, 29 cases being complex of the above two varieties, and the others were 23 cases. 197 cases being T1N0M0 , 118 cases being T2N0M0 , 6 cases being T2N1M0, 5 cases being T3N0M0, 8 cases being T3N1M0, 3 cases being T3N2M0, 22 cases being T3N0M1. 220 cases have been followed up. The 1 year survival rate was 84.47 ± 2.45% ,The 3 years survival rate was 73.26 ± 3.28%, The 5 years survival rate was 65.21 ± 4.29%, The 10 years survival rate was 55.18 ± 7.47%. Conclusion ＂Sex＂ ,＂vena cava＂ ,＂ TNM＂, ＂Robson＂ and＂ assistant treatment＂ were significant in statistics （ P 〈 0.05 ）, while ＂Age＂, ＂symptom＂, ＂course of diseases＂, ＂left or right side＂, ＂medical diseases＂,＂ surgical route＂ and＂ surgical manner＂ had no meaning （ P 〉 0.05 ）.