CAJ | 학술논문

背景与目的：乳头状肾细胞癌相对少见，目前国内对此类肿瘤的研究较少。本研究总结乳头状肾细胞癌患者的临床病理特征，并对可能影响此类患者生存的预后因素进行探索分析。方法：回顾分析64例乳头状肾细胞癌患者的临床、病理及随访资料。研究终点为总生存期，生存分析数据采用Kaplan-Meier法进行计算，并用Log-rank法对生存率进行比较，进一步对有意义的因素行COX模型多因素回归分析。结果：乳头状肾细胞癌占同期肾癌的6.04%，中位年龄为55岁(22~78岁)，54.7%的患者为无症状性肾癌。Ⅰ型肿瘤22例(34.4%)，Ⅱ型肿瘤42例(65.6%)，组织学亚型与肿瘤的TNM分期、Fuhrman分级和手术方式显著相关。中位随访时间为46.0个月(19~133个月)，共14例(21.9%)患者死亡，其中Ⅰ型1例(4.5%)，Ⅱ型13例(31.0%， P=0.018)，总生存率分别为85.7%和55.8%。单因素分析显示，伴有临床症状、Ⅱ型乳头状肾细胞癌、Fuhrman Ⅲ~Ⅳ级、淋巴结受累、远处转移和肾周脂肪侵犯是此类患者预后的影响因素，多因素分析显示，仅远处转移是影响总生存期的独立因子，差异有统计学意义(HR=14.78，P=0.004)。结论：与国外数据相比，我国乳头状肾细胞癌占肾癌的比重低，Ⅱ型肿瘤相对较常见。确诊时发生转移是影响此类患者总生存期的重要因素。
배경여목적：유두상신세포암상대소견，목전국내대차류종류적연구교소。본연구총결유두상신세포암환자적림상병리특정，병대가능영향차류환자생존적예후인소진행탐색분석。방법：회고분석64례유두상신세포암환자적림상、병리급수방자료。연구종점위총생존기，생존분석수거채용Kaplan-Meier법진행계산，병용Log-rank법대생존솔진행비교，진일보대유의의적인소행COX모형다인소회귀분석。결과：유두상신세포암점동기신암적6.04%，중위년령위55세(22~78세)，54.7%적환자위무증상성신암。Ⅰ형종류22례(34.4%)，Ⅱ형종류42례(65.6%)，조직학아형여종류적TNM분기、Fuhrman분급화수술방식현저상관。중위수방시간위46.0개월(19~133개월)，공14례(21.9%)환자사망，기중Ⅰ형1례(4.5%)，Ⅱ형13례(31.0%， P=0.018)，총생존솔분별위85.7%화55.8%。단인소분석현시，반유림상증상、Ⅱ형유두상신세포암、Fuhrman Ⅲ~Ⅳ급、림파결수루、원처전이화신주지방침범시차류환자예후적영향인소，다인소분석현시，부원처전이시영향총생존기적독립인자，차이유통계학의의(HR=14.78，P=0.004)。결론：여국외수거상비，아국유두상신세포암점신암적비중저，Ⅱ형종류상대교상견。학진시발생전이시영향차류환자총생존기적중요인소。
Background and purpose:Papillary renal cell carcinomas (PRCC) is relatively infrequent, and there are few related researches in China. This study aimed to summarize the clinical and pathological features of PRCC, and evaluate prognostic factors for patients treated with surgery.Methods:A total of 64 patients who under-went surgery for PRCC were retrospectively assessed. PRCC tissue slides from each patient were reviewed for type (ⅠorⅡ), grade, TNM stage, coagulative tumor necrosis and microvascular invasion. We estimated overall survival using the Kaplan-Meier method. Multivariate analysis was done according to the Cox proportional hazards model of factors statistically signiifcant on univariate analysis. Results:The incidence rate of ENE was 6.04%in RCC, the median age was 55 (range 22 to 78) years. The comparison of the 22 (534.4%) typeⅠPRCCs and 42 (65.6%) typeⅡPRCCs revealed that typeⅡtumors were associated with a greater stage and grade more often. The median follow-up was 46 months (range 19 to 133). Of the 64 patients, 14 died, (4.5%) with typeⅠand 13 (31.0%) with typeⅡtumors (P=0.018). The overall survival rate was 85.7%in typeⅠtumors and 55.8%in typeⅡtumors, respectively. Univariate analysis identiifed symptoms at presentation, tumor type, TNM stage and grade as prognostic factors. On multivariate analysis only metastatic RCC remained associated with decreased overall survival (HR:14.78, P=0.004). Conclusion:The per-centage of PRCC is lower and typeⅡPRCC is relatively common compared with foreign data. Metastasis at diagnosis is an independent predictive parameter of overall survival in Chinese patients with PRCC.