高危cT1期肾透明细胞癌的CT特征及危险因素分析

CT features and risk factors of high-risk clinical T1 clear cell renal cell carcinoma

目的:探讨高危cT1期肾透明细胞癌的CT表现特点及危险因素。方法:收集203例cT1期肾透明细胞癌患者的临床及影像学资料,回顾性研究术后病理提示升级为pT3a期的高危肾透明细胞癌,分析其CT特征及危险因素。结果:203例肾透明细胞癌患者中,180例(88.7%)为pT1期,23例(11.3%)升级为pT3a期。单因素分析发现,肾周筋膜增厚、肿瘤大小、肿瘤形态、肿瘤边界、瘤周侧支静脉及病理分级是升级为pT3a期的相关危险因素(P均<0.05),升级为pT3a期的患者肿瘤病理分级更高、直径更大、边界更模糊、形态更不规则,更易出现瘤周侧支静脉及肾周筋膜增厚。多因素Logistic回归分析显示,肾周筋膜增厚(OR=7.38,95%CI:2.33~23.40,P=0.001)、肿瘤边界(OR=8.74,95%CI:2.40~31.76,P=0.001)、瘤周侧支静脉(OR=7.98,95%CI:2.21~28.75,P=0.002)是升级为pT3a期的独立危险因素。结论:CT表现为边界模糊、肾周筋膜增厚及存在瘤周侧支静脉是高危cT1期肾透明细胞癌的术前危险因素。

Objective:To investigate the computed tomography(CT)features and risk factors of high-risk clinical T1(cT1)clear cell renal cell carcinoma.Methods:The clinical and imaging data of 203 patients with cT1 clear cell renal cell carci-noma were collected.The CT features and risk factors of high-risk clear cell renal cell carcinoma upstaged to pT3a stage were analyzed retrospectively.Results:One hundred and eighty patients(88.7%)were in pT1 stage and 23(11.3%)were up-staged to pT3a stage of the 203 patients with clear cell renal cell carcinoma.Univariate analysis showed that perirenal fascia thickening,tumor size,tumor morphology,tumor boundary,peritumoral collateral veins and pathological grade were related risk factors of pT3a upstaging(P<0.05).Patients with pT3a upstaging tumors have higher pathological grade,larger diameter,more blurred boundary,more irregular shape,been more prone to peritumoral collateral veins and perirenal fascial thickening.Mul-tivariate Logistic regression analysis showed that perirenal fascia thickening(OR=7.38,95%CI:2.33~23.40,P=0.001),tumor boundary(OR=8.74,95%CI:2.40~31.76,P=0.001),and peritumoral collateral veins(OR=7.98,95%CI:2.21~28.75,P=0.002)were independent risk factors for pT3a upstaging.Conclusion:Fuzzy tumor boundary,perirenal fascia thickening and presence of peritumoral collateral veins were preoperative risk factors for high-risk cT1 renal clear cell carcinoma.