T1a期肾细胞癌预后判断指标研究

Research of prognostic indicators in T1a renal cell carcinoma

目的：从病理因素出发研究T1a期肾细胞癌（RCC）预后。方法收集1996年1月至2013年1月于该院确诊的338例单发性肾细胞癌患者资料并回顾性分析其临床病理特点与疾病进展之间的关系，进而发掘对复发和远处转移产生影响的因素。结果338例患者中共有11例患者被认定为有肿瘤复发（3．3％），其中9例有明确转移病灶。多因素分析结果表明，较高的肿瘤分级（3级和4级）是肿瘤复发的独立危险因子（危险比：13．0，95％CI：3．90-43．00，P＜0．01），而肿瘤的复发和年龄、性别、肿瘤大小、组织学表现、侵犯微循环情况及手术边界状态等因素无明显相关性。5年无复发存活率在肿瘤分级较高患者为67．8％，而在分级较低患者为96．8％。结论Fuhrman核分级情况是判断T1a期RCC术后复发和转移最重要的指标之一，对于核分级较高的T1a期RCC患者需要加强术后随访和监测。

Objective To study prognostic indicators in T1a renal cell carcinoma（RCC） from perspective of pathology .Methods Three hundred and thirty - eight patients with single sex renal cell carcinoma were collected from January 1996 to January 2013 in our hospital ,we retrospectively analyzed their clinical pathological features and the relationship between the disease progression , and explored the factors that affect the recurrence and distant metastasis .Results 11 cases（3 .3% ） patients were identified as a tumor recurrence ,9 of them had a clear metastatic lesions .Multi factor analysis results showed that the high tumor grade （level 3 and level 4） was an independent risk factor for tumor recurrence （hazard the wire ：13 .0 ,95% CI ：3 .90 - 43 .00 ,P 〈 0 .01） ;while age ,sex ,tumor size ,histological manifestations ,infringement of microcirculation and the operation factors such as boundary condi‐tion had no obvious correlation with tumor recurrence .Five years relapse free survival in patients with tumor grade high was 67 .8% ,compared with 96 .8% in the lower graded .Conclusion Fuhrman nuclear grading is a reliability index to judge the progno‐sis of T1a renal cell carcinoma postoperative recurrence and metastasis ,and higher class T1a phase need strengthening postoperative follow up and monitoring .