摘要
目的分析肾嫌色细胞癌(CRCC)和乳头状肾细胞癌(PRCC)的临床病理特点及预后相关因素。方法回顾性分析2003年1月至2017年12月收治的115例非透明细胞肾细胞癌患者的病例资料,男67例,女48例,男女比例为1.4∶1。年龄(51.2±13.4)岁。71例为无症状肾癌;44例有临床症状,其中肉眼血尿10例,腰痛28例,血尿合并腰痛4例,腹部肿块2例。行开放手术49例,腹腔镜手术66例。行根治性肾切除术58例,保留肾单位手术57例。实验室检查血红蛋白异常17例(14.9%),血小板计数异常22例(19.1%),碱性磷酸酶异常18例(15.7%),乳酸脱氢酶异常16例(13.9%)。采用Kaplan-Meier生存分析法计算患者生存率。采用Cox比例回归风险模型分析影响患者预后的因素。结果本组115例,术后病理分期为T1a期57例,T1b期38例,T2a期12例,T2b期8例;区域淋巴结阳性2例,阴性113例;均无远处转移。病理类型:肾CRCC 42例,PRCCⅠ型37例、Ⅱ型36例。术后平均随访38.6个月,失访率3.5%(4/115)。115例的1、3、5年总生存率分别为99.1%、95.8%、81.1%。Kaplan-Meier生存曲线显示,PRCCⅡ型的生存时间明显短于PRCCⅠ型和CRCC,差异均有统计学意义(P<0.001);4项指标(血红蛋白、血小板计数、碱性磷酸酶、乳酸脱氢酶)≥3项异常者生存时间明显短于<3项异常者,差异有统计学意义(P<0.001)。多因素Cox回归分析结果显示,病理类型(OR=4.625,P=0.014)、4项指标≥3项异常(OR=30.853,P=0.024)、淋巴结转移(OR=35.663,P=0.006)是影响患者生存时间的独立因素。结论PRCCⅡ型的恶性程度高于PRCCⅠ型和肾CRCC,预后较差。病理类型、4项指标(血红蛋白、血小板计数、碱性磷酸酶、乳酸脱氢酶)≥3项异常及淋巴结转移是患者总生存时间的独立预后因素。
Objective To analyze the clinicopathological features and prognostic factors of common subtypes of non-transparent renal cell carcinoma.Methods Retrospective analysis of 115 patients with pathologically confirmed non-transparent renal cell carcinoma from January 2003 to December 2017,including 67 males and 48 females,with a male to female ratio of 1.4∶1.The average age is(51.2±13.4)years old.71 cases were asymptomatic renal cancer,44 cases had clinical symptoms,including 10 cases of gross hematuria,28 cases of low back pain,4 cases of hematuria with low back pain,and 2 cases of abdominal mass.There were 49 open surgery and 66 laparoscopic surgery.58 patients underwent radical nephrectomy and 57 underwent partial nephrectomy.Of the 115 patients,17(14.9%)had abnormal hemoglobin(Hb),22(19.1%)had abnormal platelet(PLT)count,18(15.7%)had abnormal alkaline phosphatase,and abnormal lactate dehydrogenase 16 cases(13.9%).The Kaplan-Meier survival analysis method was used to calculate the survival rate of patients,and the Cox proportional regression risk model was used to analyze the prognostic factors.Results The postoperative pathological stage was 57 cases in T1a stage,38 cases in T1b stage,12 cases in T2a stage,8 cases in T2b stage,2 cases of regional lymph node positive,and 113 cases negative;no distant metastasis.Pathological types:42 cases of renal chromophobe cell carcinoma,37 cases of papillary renal cell carcinoma typeⅠ,36 cases of typeⅡ.The average follow-up time was 38.6 months,and the rate of loss of follow-up was 3.5%(4/115).The 1,3,and 5 year overall survival rates of 115 patients with common subtypes of non-transparent renal cell carcinoma were 99.1%,95.8%,and 81.1%,respectively.Multivariate Cox regression analysis found that the pathological type(OR=4.625,P=0.014),four indicators≥3 abnormalities(OR=30.853,P=0.024),lymph node metastasis(OR=35.663,P=0.006)were the group.An independent factor in the survival time of patients with common subtypes of non-transparent renal cell carcinoma.Conclusions Compared with papillary renal cell carcinoma typeⅠand renal chromophobe cell carcinoma,papillary renal cell carcinoma typeⅡhas a higher degree of malignancy and a poor prognosis.The pathological types of the common subtypes of non-transparent renal cell carcinoma,four indicators(Hb,PLT count,alkaline phosphatase,and lactate dehydrogenase)≥3 abnormalities and lymph node metastasis are independent prognostic factors for overall survival.
作者
艾克拜尔·努尔买买提
王文光
乔炳璋
李前进
阿卜杜瓦日斯·阿卜力克木
木拉提·热夏提
Aikebaier· Nuermaimaiti;Wang Wenguang;Qiao Bingzhang;Li Qianjin;Abuduwarisi· Abulikemu;Mulati· Rexiati(Department of Urology,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2019年第3期167-170,共4页
Chinese Journal of Urology
关键词
非透明细胞肾细胞癌
肾嫌色细胞癌
乳头状肾细胞癌
预后
Non-transparent renal cell carcinoma
Renal chromophobe cell carcinoma
Papillary renal cell carcinoma
Prognosis
