肾嫌色细胞癌127例的临床特征及预后相关因素分析

Analysis of the clinicopathological features and prognosis of chromophobe renal cell carcinoma

目的探讨肾嫌色细胞癌的临床特征及与预后的关系。方法回顾性分析吉林大学中日联谊医院泌尿外科2011年9月至2016年9月我院收治的127例病理确诊为肾嫌色细胞癌患者的临床和随访资料。采用Kaplan-Meier生存分析法计算患者的生存率,log-rank检验生存率差异,应用Cox比例回归风险模型分析影响预后的临床因素。结果男60例,女67例,男女比例为1∶1.17。年龄24~87岁,平均(51.65±12.26)岁。pT1期肿瘤患者占73.2%(93/127),T2期19.7%(25/127),pT3期4.7%(6/127),pT4期2.4%(3/127)。肿瘤最大径为1~13.3cm,中位肿瘤最大径5.38cm。总体随访率达94.5%,127例的随访时间为6.4~67.7月,平均(26.6±16.0)个月,1、3、5年生存率分别为90.6%(115/127)、88%(44/50)、76.2%(16/21)。单因素结果分析显示术后复发(P<0.001)、pT分期(P=0.006)、淋巴结转移(P<0.001)、远处转移(P<0.001)是影响肾嫌色细胞癌生存期的因素。Cox多因素分析患者并不能从术后使用白介素-2中获益(P=0.18),根治性肾切除术(P=0.563)和远处转移(P=0.119)可能是患者生存期的危险因素。淋巴结转移(OR=36.69,P<0.001)是影响肾嫌色细胞癌患者生存时间的独立因素。结论肾嫌色细胞癌是预后较好的肾癌亚型之一,临床上肿瘤分期以T1~T2期多见(118/127),这可能和良好的预后有关。淋巴结转移是影响肾嫌色细胞癌患者生存时间的独立因素。

Objective To explore the clinicopathological features of chromophobe renal carcinoma（ChRCC）and the long-term survival of patients after surgery.Methods The clinical,pathological and follow-up data of 127 cases of ChRCC treated during Sept.2011 and Sept.2016 were retrospectively analyzed.The end point of the research was the death of patients.The survival rate of patients was estimated with Kaplan-Meier survival curve.The prognostic factors were assessed with Logrank test.The influencing factors of prognosis were analyzed with Cox regression model.Results There were 60 males and 67 females,and the male/female（M/F）ratio was 1∶1.17.The patients aged 24-87 years,average（51.65±12.26）years.According to the 2010 AJCC TNM staging system,73.2% of the cases were pT1,19.7% were pT2,4.7% were pT3 and 2.4%were pT4.The average size of tumor was 1-13.3 cm,median 5.38 cm.The overall follow-up rate were 94.5%.The follow-up was 6.4-67.7 months,and the average overall survival was 26.6±16.0 months.The 1-year,3-year,and5-year survival rate was90.6%（115/127）,88%（44/50）,and 76.2%（16/21）,respectively.Single factor analysis showed that relapse after surgery（P〈0.001）,T stage（P=0.006）,distant metastasis（P〈0.001）and lymph node metastasis（P〈0.001）were significant prognostic factors of ChRCC.Cox multivariate analysis indicated that patients could not benefit from IL-2 after surgery（P=0.18）;nephrectomy（P=0.563）and distant metastasis（P=0.119）were the possible risk factors,and lymph node metastasis（OR=36.69,P〈0.0010）was the independent predictive factor.Conclusion As a subtype of renal cancer,ChRCC shows a low degree of malignancy and good prognosis.Most cases are in the pT1 and the pT2 stage.IL-2 after surgery does not benefit patients.Lymph node metastasis is the independent prognostic factor.