798例透明细胞肾细胞癌WHO/ISUP分级与临床病理特征及预后的关系

Correlation of WHO/ISUP grade with clinicopathologic features and prognosis of 798 cases of clear cell renal cell carcinoma

目的探讨透明细胞肾细胞癌(clear cell renal cell carcinoma,CCRCC)WHO/ISUP分级与临床病理学特征及预后的关系。方法回顾性分析2007年8月~2014年12月浙江大学医学院附属第一医院798例行肾全切术且病理诊断为CCRCC患者的临床病理资料及随访信息。结果798例CCRCC中,男女比为1.9∶1,平均年龄57.4岁,肿瘤平均最大径5.1 cm。出现脉管内癌栓者42例(5.3%),紧贴/累犯肾被膜303例(38.0%),肿瘤发生坏死89例(11.2%),WHO/ISUP 1~4级分别为120例(15.0%)、495例(62.0%)、158例(19.8%)、25例(3.2%);病理分期:Ⅰ+Ⅱ期749例(93.9%),Ⅲ+Ⅳ期49例(6.1%)。544例患者获得随访,其中67例死于肾细胞癌,术后5年总生存率为93.4%,10年总生存率86.7%。WHO/ISUP分级越高的患者年龄越大、肿瘤最大径更长、更易出现脉管癌栓并紧贴/累犯肾被膜、肿瘤更易发生坏死且病理分期更高(P均<0.05)。单因素生存分析显示,手术时患者年龄>60岁、肿瘤最大径>7.0 cm、有脉管癌栓、紧贴/累犯肾被膜、发生肿瘤坏死、WHO/ISUP分级高、病理分期高的患者预后不良(P均<0.05)。Cox多因素生存分析显示,患者年龄、肿瘤最大径及WHO/ISUP分级为CCRCC患者的独立预后因素(P均<0.05)。结论WHO/ISUP分级高的CCRCC患者预后差;患者年龄、肿瘤最大径及WHO/ISUP分级为CCRCC患者的独立预后因素。

Purpose To explore the relationship between the WHO/ISUP grade and clinicopathological characteristics and its influence on the prognosis of patients with clear-cell renal cell carcinoma(CCRCC).Methods The clinicopathological and survival data of 798 patients who underwent radical nephrectomy and pathological diagnosis of CCRCC from August 2007 to December 2014 in the First Affiliated Hospital of Zhejiang University were collected.Results Among 798 CCRCC patients,the ratio of male to female was 1.9∶1,the average age was 57.4 years,and the average tumor maximum diameter was 5.1 cm.There were 42 cases(5.3%)with intravascular tumor thrombus,303 cases(38.0%)close to/invade the renal capsule,89 cases(11.2%)with tumor necrosis.WHO/ISUP grade 1 to 4 were 120 cases(15.0%),495 cases(62.0%),158 cases(19.8%),and 25 cases(3.2%),respectively.Pathological TNM staging was 749 cases(93.9%)fromⅠtoⅡ,and 49 cases(6.1%)fromⅢtoⅣ.A total of 544 patients were followed up,of which 67 died of renal cell carcinoma.The overall 5-year and 10-year survival rates after surgery were 93.4%and 86.7%,respectively.Chi-square test analysis showed that patients with higher WHO/ISUP grades were older,had longer maximum tumor diameters,were more likely to develop vascular tumor thrombus and to adjacent/invade the renal capsule,and were more prone to necrosis and higher pathological TNM stage(P<0.05).In addition,univariate survival analysis showed that patients who were over 60 years old at the time of surgery,tumor with a maximum diameter of more than 7.0 cm,vascular tumor thrombus,close to/invade the renal capsule,tumor necrosis,higher WHO/ISUP grade or pathological TNM stage were significantly associated with a poor prognosis(P<0.05).Cox multivariate survival analysis showed that age,tumor diameter and WHO/ISUP grade were independent prognostic factors for CCRCC patients(P<0.05).Conclusion WHO/ISUP classification is an independent unfavorable factor for CCRCC patients.Age,tumor diameter and WHO/ISUP grade are independent prognostic factors for CCRCC patients.