T_3N_0M_0期肾细胞癌患者预后相关因素分析:单中心182例患者回顾性研究

Prognostic factors of patients with T_3N_0M_0 renal cell carcinoma: a single-center retrospective study of 182 patients

目的：研究影响T_3N_0M_0期肾细胞癌患者肿瘤学预后的临床及实验室检查因素。方法：回顾性分析2007年至2012年于北京大学第一医院行手术治疗的T_3N_0M_0肾细胞癌患者的临床资料、实验室检查结果及随访数据。应用Kaplan-Meier法计算生存率,Log-rank方法进行单因素分析,对单因素分析中显著相关的变量采用Cox模型进行多因素生存分析。结果：共182例T_3N_0M_0肾细胞癌患者纳入研究,其中男性患者126例（69.23%）,女性患者56例（30.77%）。患者平均年龄为（56.75±12.45）岁,中位随访时间48个月（3～99个月）,末次随访时共有50例（27.47%）患者死亡,59例患者（32.42%）复发。患者的5年肿瘤特异性生存率为68.30%（95%CI：60.16%～75.84%）,5年无复发生存率为60.70%（95%CI：53.16%～68.84%）。多因素分析发现,糖尿病（HR=2.434,95%CI：1.243～4.769,P=0.010）、术前低白蛋白血症（HR=2.188,95%CI：1.074～1.074,P=0.031）及贫血（HR=3.320,95%CI：1.839～5.991,P〈0.001）是T_3N_0M_0肾细胞癌患者术后肿瘤特异生存的独立危险因素,更高的Fuhrman分级（HR=2.552,95%CI：1.433～4.545,P=0.001）、术前贫血（HR=2.535,95%CI：1.497～4.293,P=0.001）是T_3N_0M_0肾细胞癌患者术后复发的独立危险因素。结论：糖尿病、术前低白蛋白血症、贫血是T_3N_0M_0肾细胞癌患者术后生存的独立危险因素;高Fuhrman分级、贫血是T_3N_0M_0肾细胞癌患者术后复发的独立危险因素。

Objective： To evaluate the impacts of clinical,pathological,and laboratory factors on oncological outcomes of patients with T3N0M0 renal cell carcinoma. Methods： The clinical data,laboratory exam results,and follow-up outcomes of 182 patients with T3N0M0 renal cell carcinoma who underwent nephrectomy from 2007 to 2012 in Peking University First Hospital were retrospectively collected. The 5-year cancer-specific survival and 5-year recurrence-free survival of all the patients were calculated using Kaplan-Meier method,and the statistical significance between the survival curves were compared using the Log-rank test. Variables with significant differences in the univariate analysis were subjected to the multivariate analysis by Cox regression model. All the comparisons were conducted using two-tailed test and P 0. 05 was considered statistically significant. Results： A total of 182 patients were included in this study. Of all the 182 patients,126 were male（ 69. 23%） and 56 were female（ 30. 77%）. The mean age was（ 56. 75 ± 12. 45） years. The median follow-up time was 48 months（ 3- 99 months）. At the end of the follow-up,50 patients（ 27. 47%） died due to the disease after a median of 29. 74 months and 59 patients（ 32. 42%） had tumor recurrence after a median of 22. 12 months. The 5-year cancerspecific survival of all patients was 68. 30%（ 95% CI： 60. 16%- 75. 84%）; the 5-year recurrence-free survival was 60. 70%（ 95% CI： 53. 16%- 68. 84%）. In the univariate analysis,diabetes mellitus,tumor invasion status,Fuhrman grade,serum album,serum cholestenone,anemia,and neutrophils percentage were associated with the cancer-specific survival and Fuhrman grade,serum album and anemia were associated with the recurrence-free survival. Variables with significant differences on univariate analysis were included in Cox multivariate regression analysis. Multivariate Logistic regression analysis showed that diabetes mellitus（ HR = 2. 434,95% CI： 1. 243- 4. 769,P = 0. 010）,hypoalbuminemia（ HR = 2. 188,95% CI： 1. 074- 1. 074,P = 0. 031）,and anemia（ HR = 3. 320,95% CI： 1. 839-5. 991,P 0. 001） were independent risk factors significantly associated with cancer-specific survival;and higher Fuhrman grade（ HR = 2. 552,95% CI： 1. 433- 4. 545,P = 0. 001）,anemia（ HR = 2. 535,95% CI： 1. 497- 4. 293,P = 0. 001） were independent factors significantly associated with recurrencefree survival. Conclusion： Diabetes mellitus,hypoalbuminemia,and anemia were independent risk factors significantly associated with cancer-specific survival of T3N0M0 renal cell carcinoma patients; higher Fuhrman grade and anemia were independent risk factors significantly associated with tumor recurrence of T3N0M0 renal cell carcinoma patients.