原发性肾透明细胞癌根治术患者预后与CD99基因表达的关系及预后影响因素分析

Relationship between prognosis of patients with primary clear cell renal cell carcinoma after radical nephrectomy and expression of CD99 and analysis of prognostic factors

目的探讨影响原发性肾透明细胞癌(clear cell renal cell carcinoma,ccRCC)根治术患者的预后与肿瘤转移相关基因CD99的关系及预后的影响因素。方法应用半定量RT-PCR技术研究CD99基因在ccRCC组织和癌旁组织中的表达,通过随访调查患者的预后、生存时间及其危险因素,应用Cox风险回归模型分析获得影响预后的主要危险因素。结果与对应癌旁组织相比,CD99基因在ccRCC组织中表达上调的占73.5%,差异有统计学意义(P=0.000)。应用Cox风险回归模型分析发现:ccRCC组织中CD99基因的高表达[HR=0.14,95%CI(0.01,2.15)]与根治术患者预后的生存时间无关;而患者年龄[HR=1.18,95%CI(1.01,1.38)]、TNM分期[HR=51.91,95%CI(4.31,625.87)]、合并糖尿病[HR=59.94,95%CI(2.21,1 627)]和合并高血压[HR=47.72,95%CI(1.37,1 670)]是影响患者预后生存时间的主要危险因素。比较TNMⅠ期和Ⅱ～Ⅳ期两组患者的1年生存率和2年生存率(100.0%vs 60.0%,P=0.004;93.8%vs 8.3%,P=0.000),差异有统计学意义。结论肿瘤转移相关基因CD99的表达可能与ccRCC的预后无关,年龄、TNM分期、合并糖尿病和合并高血压是影响患者预后生存时间的主要危险因素。

Objective To investigate the relationship between prognosis of patients with primary clear cell renal cell carcinoma（ccRCC） after radical nephrectomy and expression of tumor metastasis-associated gene CD99 and to analyze the prognostic factors of ccRCC patients.Methods Semi-quantitative reverse transcription-polymerase chain reaction（RT-PCR） was used to examine the expression of CD99 in primary ccRCC tissues and their corresponding adjacent tissues.The prognosis and risk factors of survival time of patients were studied by follow-up investigation,and the main risk factors were screened by Cox hazard regression model.Results Compared with the adjacent renal tissues,73.5% ccRCC tissues had up-regulated CD99 expression,with significant difference found between the two groups（P=0.000）.Cox hazard regression model showed that high CD99 expression in ccRCC tissues was not a survival risk factor of ccRCC patients after radical nephrectomy （HR=0.14,95%CI[0.01,2.15]）;and age （HR= 1.18,95%CI[1.01,1.38]）,TNM stages （HR=51.91,95%CI[4.31,625.87]）,diabetes （HR=59.94,95%CI[2.21,1 627]） and hypertension （HR=47.72,95%CI[1.37,1 670]） were the major risk factors for the survival of patients after radical nephrectomy.The 1-year and 2-year survival rates of ccRCC patients in TNM stage Ⅰ were significantly higher than those in TNM stage Ⅱ-Ⅳ,respectively（100.0% vs 60.0%,P=0.004;93.8% vs 8.3%,P=0.000）.Conclusion The expression of tumor metastasis-related gene CD99 may not be associated with the prognoses of ccRCC patients.Age,TNM stage,diabetes and hypertension are the major risk factors of prognosis after resection of ccRCC.