213例偶发肾癌的临床特点及预后分析

Clinical features and prognosis of 213 patients with incidental renal cell carcinomas

背景与目的:肾细胞癌(renal cell carcinoma,RCC)是最常见的肾实质恶性肿瘤,在泌尿生殖系统肿瘤的发病率仅次于膀胱癌。近年来,肾癌的发病率呈上升趋势,其中偶发肾癌的检出率逐年提高。本研究旨在探讨偶发肾癌的临床特点,分析影响肾癌预后的相关因素。方法:回顾性分析369例肾癌患者的临床资料,分为偶发肾癌组(n=213)和非偶发肾癌组(n=156),按年龄、性别、肿瘤位置、肿瘤直径、病理类型、病理分期及肿瘤细胞分级统计各组病例数,计算各组生存率,比较两组中晚期肾癌的平均生存时间。结果:偶发肾癌与非偶发肾癌相比较,发病年龄、性别、肿瘤位置及病理类型差异无统计学意义(P>0.05),偶发肾癌肿瘤直径较小,病理分期、病理分级均较低(P<0.05),发生远处转移较少(P<0.05)。偶发癌1、3及5年生存率为98.05%、85.62%及75.83%,非偶发癌为90.02%、65.21%及60.57%,两组相比差异有统计学意义(P<0.05)。偶发肾癌组与非偶发肾癌组的Ⅲ、Ⅳ期平均生存时间分别为26个月与22个月、16个月与14个月,log-rank检验差异均无统计学意义(P>0.05)。Cox多因素分析提示TNM分期、是否为偶发癌、细胞分级和远处转移为影响肾癌预后的独立因素(P<0.05)。结论:偶发肾癌多为低分期、低分级,较少发生远处转移,术后生存率高于非偶发肾癌,影响术后肾癌预后的独立因素为:是否偶发、肿瘤TNM分期、远处转移和肿瘤细胞分级。

Background and purpose： Renal cell carcinoma （RCC） is the most common renal malignant tumor. The incidence rate of RCC in the genitourinary system is second only to bladder cancer. In recent years, the incidence rate of kidney cancer has risen, in which the detection rate of incidental RCC has also increased. The aim of the current study was to investigate the clinical characteristics and related prognostic factors of incidental RCC. Methods： Clinical data of 369 cases with RCC were analyzed retrospectively. Patients were divided into 2 groups, 213 cases of incidental RCC and 156 cases of non-incidental RCC, where age, gender, tumor location, tumor size, pathological types, TNM staging and tumor cell grades on disease, and overall survival were evaluated for each group. The average survival rate of advanced kidney cancer was compared in the 2 groups. Results： There were no differences between the 2 groups on age, gender, tumor location and pathological tissue types （P〉0.05）. However, incidental RCC might be of smaller size, lower stage and grade than symptomatic ones （P〈0.05）, and less distant metastasis （P〈0.05）. The overall 1-, 3-, and 5-year cumulative survival rate were 98.05%, 85.62% and 75.83% respectively in incidental group, while 90.02%, 65.21% and 60.57% respectively in symptomatical group. The difference between groups was significant （P〈0.05）. The average survival time of stage Ⅲ in 2 groups was 26 months and 22 months, stage Ⅳ was 16 months and 14 months, respectively. Log-rank test showed no significant difference （P〉0.05）. Conclusion： The incidental RCC has low stage and higher survival rate after operation, and less distant metastasis. The independent prognostic factors, which affect the postoperative survival, include clinical presentation, TNM stage, distant metastasis and tumor cell grade.