334例肾细胞癌患者的预后因素分析

Analysis of prognostic factors in 334 patients with renal cell carcinoma

目的 :分析影响肾细胞癌患者的预后因素。方法 :研究对象为2008年1月—2013年12月在新疆医科大学附属肿瘤医院泌尿科确诊的334例初治肾细胞癌患者,均有完整的临床病理资料和随访资料。应用Kaplan-Meier法进行预后的单因素分析,采用COX回归模型进行预后的多因素分析。结果 :随访期间,334例患者中有43例因肾细胞癌死亡(12.9%),69例(20.7%)出现疾病复发或进展。334例患者的1年、3年和5年生存率分别为95.2%、86.3%和83.6%。血清钙水平、病理类型、TNM分期、肿瘤有无坏死以及有无静脉癌栓是肾细胞癌患者的独立预后因素(P值均<0.05)。亚组分析结果显示,肾细胞癌根治术组与保留肾单位手术组患者的5年生存率差异无统计学意义(P>0.05),开放手术与腹腔镜手术的5年生存率差异亦无统计学意义(P>0.05)。结论 :血清钙水平、病理类型、TNM分期、肿瘤有无坏死以及有无静脉癌栓是肾细胞癌患者的独立预后因素。对存在不良预后因素的患者应给予积极的综合治疗以提高生存率。

Objective：To analyze the factors affecting the prognosis of patients with renal cell carcinoma.Methods：The clinical records and follow-up information of 334 patients with primary renal cell carcinoma initially treated in Department of Urology,Tumor Hospital Affiliated to Xinjiang Medical University between January 2008 and December 201 3 were collected.All the patients had complete clinical and follow-up information.The univariate analysis of prognostic factors was performed by Kaplan-Meier method.The multivariate analysis of prognostic factors was performed by COX regression model.Results：During follow-up,of 334 patients,43（12.9%） died of renal cell carcinoma and 69（20.7%） developed recurrence and progression.The 1-,3-,and 5-year survival rates of 334 patients were 95.2%,86.3%and 83.6%,respectively.Five factors including serum calcium level,pathological type,TNM staging,tumor necrosis and venous tumor thrombus were independent prognostic factors（all P〈0.05）.Subgroup analysis revealed that the 5-year survival rate was not significantly different between the patients undergoing radical resection and nephron sparing surgery（P〉0.05）,as well as not significantly different between open surgery and laparoscopic surgery（P〉0.05）.Conclusion：The main factors,which can influence the prognosis of patients with renal cell carcinoma,include serum calcium level,pathological type,TNM staging,tumor necrosis and venous tumour thrombus.The patients having poor prognostic factors should be treated with comprehensive treatment to increase the survival rate.