单中心十年1102例肾恶性肿瘤生存预后及危险因素分析

Analysis of survival,prognosis and risk factors of 1102 cases of renal malignant tumors in a single center

目的:分析某中心近10年肾癌手术患者的临床、病理特征及预后。方法:纳入2009年1月-2018年12月于南京医科大学第一附属医院泌尿外科就诊且术后病理证实为肾恶性肿瘤的1102例患者,收集临床及预后随访信息。结果:肾癌患者年龄分布在56~65岁的比例最高(28.7%),男女比例分别为66.2%、33.8%。左、右侧肾癌比例分别为48.1%、50.5%,双侧肾癌占比为1.4%。肿瘤平均直径为4.5(0.2~17.0)cm,肾根治性切除和肾部分切除手术比例分别为51.5%、48.5%。病理类型以肾透明细胞癌最常见。年龄超过65岁(HR=1.64)、双侧肿瘤(HR=3.71)、根治性肾切除术(HR=3.08)、开放的手术方式(HR=2.35)、更久的住院时间(超过28 d,HR=3.69)、更大的肿瘤直径(>7~<10 cm,HR=4.68;≥10 cm,HR=6.55)以及更晚的临床分期(Ⅱ期、Ⅲ期和Ⅳ期,HR分别为4.65、2.65和5.80),都是影响患者的危险因素。结论:肾恶性肿瘤以肾透明细胞癌最常见,手术治疗后总体预后较好。充分认识影响预后的危险因素有助于指导临床进行精准治疗,改善患者预后。

Objective:To analyze the clinical,pathological characteristics and prognosis of 1102 renal cancer patients in the Urology Department of the First Affiliated Hospital of Nanjing Medical University in the past ten years. Methods:Collected clinical and prognostic follow-up information of 1102 patients who were operated at the Department of Urology,the First Affiliated Hospital of Nanjing Medical University from January 2009 to December 2018. Results:The high incidence of kidney cancer was 56 years old(14~91 y),and the male and female ratios were 66.2% and 33.8%,respectively. The proportion of left and right kidney cancer was48.1% and 50.5%,and the proportion of bilateral kidney cancer was 1.4%. The average tumor diameter was 4.45 cm(0.2~17.0 cm),and the proportions of radical nephrectomy and partial nephrectomy were 51.5% and 48.5%,respectively. The most common pathological type is clear cell carcinoma. The one-year survival rate after renal cancer surgery and the five-year survival rate after surgery were 93.1%. Age over 65 y(HR=1.64),bilateral tumor(HR=3.71),radical nephrectomy(HR=3.08),open surgical approach(HR=2.35),longer hospitalization time(more than 28 days,HR=3.69),larger tumor diameter(greater than 7 cm and less than 10 cm,HR=4.68,greater than or equal to 10 cm,HR=6.55)and later clinical stage(stage Ⅱ,Ⅲ and Ⅳ,HR were 4.65,2.65 and 5.80,respectively),all of which were risk factors affecting the prognosis of patients. Conclusion:Renal clear cell carcinoma is the most common malignant tumor of the kidney,and the overall prognosis after surgical treatment is better. The influencing factors found in this study are useful to guide the clinical precision treatment and improve the prognosis of patients.