肾细胞癌随访5年生存分析及预后相关因素的多中心研究

A multicenter study of prognostic factors of renal cell carcinoma： survival analysis based on follow-up over 5 years

目的 分析肾细胞癌患者术后长期生存情况及其相关预后因素. 方法 对国内4家医院泌尿外科2000-2008年手术治疗的1544例非转移性肾细胞癌进行回顾性分析,收集并统计其长期随访生存情况及其与性别、年龄、肿瘤组织学类型、分级、分期、淋巴结转移情况、手术方式等可能的预后因素的关系. 结果 1 544例中,男1041例（67.4％）,女503例（32.6％）.肿瘤最大径（5.4±3.1）cm,中位数4.7 cm.透明细胞癌1371例（88.8％）,乳头状癌89例（5.8％）,嫌色细胞癌44例（2.8％）,集合管癌4例（0.3％）,其他未分类肾癌36例（2.3％）.Fuhrman分级Ⅰ级322例（24.8％）,Ⅱ级791例（60.8％）,Ⅲ级168例（12.9％）,Ⅳ级20例（1.5％）.根据2010年AJCC TNM标准分期,pT1期1162例（75.3％）,pT2期247例（16.0％）,pT3期103例（6.7％）,pT4期24例（1.6％）;淋巴结情况N0 1491例（96.6％）,N153例（3.4％）.1 544例总体随访率93.4％,平均随访时间（59.8±23.3）个月,1、3、5年生存率分别为98.2％、93.4％和89.4％.3种组织学亚型（透明细胞癌、乳头状癌、嫌色细胞癌）间比较,生存率差异无统计学意义（P=0.935）,其5年生存率分别为90.1％、85.8％、89.6％.Fuhrman Ⅰ～Ⅳ级5年生存率分别为93.6％、91.1％、84.2％、36.5％;T1～ T4肿瘤5年生存率分别为93.5％、84.5％、60.7％、70.0％;淋巴结阴性者5年生存率为91.3％,淋巴结转移者为37.1％.Fuhrman分级（P=0.000）、T分期（P=0.000）、淋巴结转移（P=0.000）是肾癌手术后预后的影响因素.多因素分析结果显示,年龄≥55岁、高级别肿瘤（FuhrmanⅢ～Ⅳ级）、肿瘤大小、肿瘤分期达T3和淋巴结转移为影响肾癌手术后预后的独立危险因素,性别、肿瘤侧别、手术方式不是影响预后的独立危险因素. 结论 对非转移肾细胞癌术后患者,年龄、肿瘤大小、分级、分期和淋巴结转移情况是5年总体生存的独立预后因素.

Objective To analyze long-term survival of renal cell carcinoma （RCC） after surgery and its prognostic factors.Methods A total of 1544 non-metastatic RCCs who underwent surgery from 2000 to 2008 in 4 medical centers in China were enrolled.The long-term survival information as well as possible prognostic factors,including age,sex,tumor histologic subtype,grading,staging,lymph node metastasis,type of surgery,etc.,were collected and analyzed.Results Of all the 1544 patients,1 041 were male and 503 were female.The average size of lesion was 5.4±3.1 cm,with median at 4.7 cm.Histologic subtype was clear cell RCC in 1371 （88.8%）,papillary in 89 （5.8%）,chromophobe in 44 （2.8%）,collecting duct in 4 （0.3%） and other subtypes in 36 （2.3%）.Fuhrman grading was Ⅰ in 322 （24.8%）,Ⅱ in 791 （60.8%）,Ⅲ in 168 （12.9%） and Ⅳ in 20 （1.5%）.Tumor staging according to 2010 AJCC TNM staging system was pT1 in 1162 （75.3%）,pT2 in 247 （16.0%）,pT3 in 103 （6.7%） and pT4 in 24 （1.6%）.Lymph node metastasis was negative in 1491 （96.6%）,positive in 53 （3.4%）.The overall follow-up rate was 93.4% with a median follow-up time of 59.8±23.3 months.The 1-year,3-year and 5-year overall survival rate was 98.2%,93.4% and 89.4%.There was no significant difference among the three main histologic subtypes （P=0.935）.The 5-year overall survival for clear cell,papillary and chromophobe RCC was 90.1%,85.8% and 89.6%,respectively.The 5-year overall survival for Fuhrman Ⅰ to Ⅳ was 93.6%,91.1%,84.2% and 36.5%,respectively.The 5-year overall survival for pT1,pT2,pT3 and pT4 was 93.5%,84.5%,60.7% and 70.0%,respectively.Patients with no lymph node metastasis had a 5-year overall survival of 91.3%,significantly higher than that of patients with lymph node metastasis （37.1%）.Fuhrman grading,T staging and lymph node metastasis were significant prognostic factors in Log-rank test.In the multivariate analysis,age ≥ 55 years,high grade （Fuhrman Ⅲ-Ⅳ） tumors,tumor size,tumor staging over T3 and lymph node metastasis were independent prognostic factors,while sex,side of tumor and type of surgery were not.Conclusion In non-metastatic RCC receiving surgical therapy,age,tumor size,grading,staging and lymph node metastasis are independent prognostic factors for 5-year overall survival.