乳头状肾细胞癌患者的临床特点及预后相关因素分析

Analysis of clinical characteristics and prognostic factors of patients with papillary renal cell carcinoma

目的分析乳头状肾细胞癌(PRCC)患者的临床特点及影响预后的相关因素。方法收集2003年1月-2018年12月新疆医科大学第一附属医院泌尿外科收治的72例PRCC患者的临床资料,其中男性47例,女性25例,男女比例为1.88∶1。年龄(51.93±14.07)岁。收集患者临床资料,包括性别、年龄(≥60岁和<60岁)、高血压(伴有和不伴有)、5项指标异常(血红蛋白降低、血清钙升高、血小板计数增高、乳酸脱氢酶升高、碱性磷酸酶升高,≥3项和<3项)、病理类型(I型和Ⅱ型)、临床分期、淋巴结转移(有和无)、Fuhrman分级、体质指数、吸烟、饮酒、手术方式,通过门诊、住院、电话随访患者生存情况。采用Kaplan-Meier法进行单因素分析,采用COX回归分析法进行多因素分析。结果本组72例患者年龄≥60岁25例,<60岁47例。伴高血压病17例(23.61%),实验室检查5项指标:血红蛋白降低12例、血清钙升高14例、血小板计数升高13例、乳酸脱氢酶异常13例、碱性磷酸酶升高9例,其中5项指标异常≥3项3例,<3项异常69例。PRCC I型36例、Ⅱ型36例。临床分期:Ⅰ期61例,Ⅱ期9例,Ⅲ期2例;区域淋巴结阳性2例,阴性70例;均无远处转移。Fuhrman分级1级21例,2级20例,3级23例,4级8例,术后平均随访54.0个月,失访率2.77%(2/72)。经Kaplan-Meier法分析结果显示,年龄(P=0.009)、高血压(P=0.014)、淋巴结转移(P<0.001)、5项指标异常≥3项(P<0.001)、病理类型(P=0.027)、临床分期(P<0.001)和Fuhrman分级(P=0.001)均为影响患者生存的影响因素。经多因素COX回归分析结果显示,年龄≥60岁,5项指标异常≥3项为影响患者生存的独立影响因素,HR分别为5.410(1.391~21.047)和35.704(2.481~513.861),对应的P值分别为0.015、0.009。结论PRCCII型患者的预后差,年龄≥60岁、5项指标异常≥3项是影响PRCC患者生存的独立危险因素。

Objective To analyze the clinical characteristics and prognostic factors of papillary renal cell carcinoma(PRCC).Methods The clinical data of 72 patients with PRCC admitted to Urology Department of the First Affiliated Hospital of Xinjiang Medical University from January 2003 to December 2018 were collected,including 47 males and 25 females,with a male to female ratio of 1.88∶1.The average age was(51.93±14.07)year-old.The clinical data of the patients were recorded,including sex,age(≥60 years and<60 years),hypertension(with and without),five abnormal indicators(hemoglobin decrease,serum calcium increase,platelet count increase,lactate dehydrogenase increase,alkaline phosphatase increase)and etc.Kaplan-Meier method was to compare the survival differences among the groups.COX multiple factor regression analysis was to explore the independent factors affecting the survival of tumor patients.Results In this study,25 cases were over 60 year-old and 47 cases were under 60 year-old.17 cases were hypertension(23.61%).There were 12 cases of hemoglobin decrease,14 cases of serum calcium increase,13 cases of platelet count increase,13 cases of lactate dehydrogenase abnormality,and 9 cases of alkaline phosphatase increase.Among them,there were 3 cases of≥3 abnormalities of the five indicators,while 69 cases of<3 abnormalities.There were 36 cases of PRCC type I and 36 cases of PRCC type II.Clinical stages:61 cases were in stage I,9 cases in stage II,and 2 cases in stage III;only 2 cases in regional lymph nodes were positive,while 70 cases were negative;there was no distant metastasis.21 cases belonged to Fuhrman′s grade 1,20 cases to grade 2,23 cases to grade 3,and 8 cases to grade 4.The average follow-up time was 54.0 months,and the missing rate was 2.77%(2/72).The results of Kaplan-Meier analysis showed that age(P=0.009),hypertension(P=0.014),lymph node metastasis(P<0.001),≥3 abnormalities of the five indicators(P<0.001),pathological type(P=0.027),clinical stage(P<0.001)and Fuhrman grade(P=0.001)were all factors affecting the survival of patients.The results of multivariate COX regression analysis showed that≥60 year-old and≥3 abnormalities of the five indicators were independent risk factors for the survival of patients,the HR of which were 5.410(1.391-21.047)and 35.704(2.481-513.861),respectively(P=0.015 and 0.009).Conclusion The prognosis of patients with PRCC type II is poor.≥60 year-old and≥3 abnormalities of the five indicators are the independent risk factors for the survival of patients with PRCC.