中华泌尿外科杂志
中華泌尿外科雜誌
중화비뇨외과잡지
CHINESE JOURNAL OF UROLOGY
2015年
2期
113-117
,共5页
张进%王共先%郭剑明%齐隽%朱冶华%陈勇辉%薛蔚%刘东明%黄翼然
張進%王共先%郭劍明%齊雋%硃冶華%陳勇輝%薛蔚%劉東明%黃翼然
장진%왕공선%곽검명%제준%주야화%진용휘%설위%류동명%황익연
癌,肾细胞%预后%危险因素%多中心研究
癌,腎細胞%預後%危險因素%多中心研究
암,신세포%예후%위험인소%다중심연구
Carcinoma,renal cell%Prognosis Risk factors Multicenter studies
目的 分析肾细胞癌患者术后长期生存情况及其相关预后因素. 方法 对国内4家医院泌尿外科2000-2008年手术治疗的1 544例非转移性肾细胞癌进行回顾性分析,收集并统计其长期随访生存情况及其与性别、年龄、肿瘤组织学类型、分级、分期、淋巴结转移情况、手术方式等可能的预后因素的关系. 结果 1 544例中,男1 041例(67.4％),女503例(32.6％).肿瘤最大径(5.4±3.1)cm,中位数4.7 cm.透明细胞癌1 371例(88.8％),乳头状癌89例(5.8％),嫌色细胞癌44例(2.8％),集合管癌4例(0.3％),其他未分类肾癌36例(2.3％).Fuhrman分级Ⅰ级322例(24.8％),Ⅱ级791例(60.8％),Ⅲ级168例(12.9％),Ⅳ级20例(1.5％).根据2010年AJCC TNM标准分期,pT1期1 162例(75.3％),pT2期247例(16.0％),pT3期103例(6.7％),pT4期24例(1.6％);淋巴结情况N0l 491例(96.6％),N153例(3.4％).1 544例总体随访率93.4％,平均随访时间(59.8±23.3)个月,1、3、5年生存率分别为98.2％、93.4％和89.4％.3种组织学亚型(透明细胞癌、乳头状癌、嫌色细胞癌)间比较,生存率差异无统计学意义(P=0.935),其5年生存率分别为90.1％、85.8％、89.6％.Fuhrman Ⅰ～Ⅳ级5年生存率分别为93.6％、91.1％、84.2％、36.5％;T1～ T4肿瘤5年生存率分别为93.5％、84.5％、60.7％、70.0％;淋巴结阴性者5年生存率为91.3％,淋巴结转移者为37.1％.Fuhrman分级(P=0.000)、T分期(P=0.000)、淋巴结转移(P=0.000)是肾癌手术后预后的影响因素.多因素分析结果显示,年龄≥55岁、高级别肿瘤(FuhrmanⅢ～Ⅳ级)、肿瘤大小、肿瘤分期达T3和淋巴结转移为影响肾癌手术后预后的独立危险因素,性别、肿瘤侧别、手术方式不是影响预后的独立危险因素. 结论 对非转移肾细胞癌术后患者,年龄、肿瘤大小、分级、分期和淋巴结转移情况是5年总体生存的独立预后因素.
目的 分析腎細胞癌患者術後長期生存情況及其相關預後因素. 方法 對國內4傢醫院泌尿外科2000-2008年手術治療的1 544例非轉移性腎細胞癌進行迴顧性分析,收集併統計其長期隨訪生存情況及其與性彆、年齡、腫瘤組織學類型、分級、分期、淋巴結轉移情況、手術方式等可能的預後因素的關繫. 結果 1 544例中,男1 041例(67.4％),女503例(32.6％).腫瘤最大徑(5.4±3.1)cm,中位數4.7 cm.透明細胞癌1 371例(88.8％),乳頭狀癌89例(5.8％),嫌色細胞癌44例(2.8％),集閤管癌4例(0.3％),其他未分類腎癌36例(2.3％).Fuhrman分級Ⅰ級322例(24.8％),Ⅱ級791例(60.8％),Ⅲ級168例(12.9％),Ⅳ級20例(1.5％).根據2010年AJCC TNM標準分期,pT1期1 162例(75.3％),pT2期247例(16.0％),pT3期103例(6.7％),pT4期24例(1.6％);淋巴結情況N0l 491例(96.6％),N153例(3.4％).1 544例總體隨訪率93.4％,平均隨訪時間(59.8±23.3)箇月,1、3、5年生存率分彆為98.2％、93.4％和89.4％.3種組織學亞型(透明細胞癌、乳頭狀癌、嫌色細胞癌)間比較,生存率差異無統計學意義(P=0.935),其5年生存率分彆為90.1％、85.8％、89.6％.Fuhrman Ⅰ～Ⅳ級5年生存率分彆為93.6％、91.1％、84.2％、36.5％;T1～ T4腫瘤5年生存率分彆為93.5％、84.5％、60.7％、70.0％;淋巴結陰性者5年生存率為91.3％,淋巴結轉移者為37.1％.Fuhrman分級(P=0.000)、T分期(P=0.000)、淋巴結轉移(P=0.000)是腎癌手術後預後的影響因素.多因素分析結果顯示,年齡≥55歲、高級彆腫瘤(FuhrmanⅢ～Ⅳ級)、腫瘤大小、腫瘤分期達T3和淋巴結轉移為影響腎癌手術後預後的獨立危險因素,性彆、腫瘤側彆、手術方式不是影響預後的獨立危險因素. 結論 對非轉移腎細胞癌術後患者,年齡、腫瘤大小、分級、分期和淋巴結轉移情況是5年總體生存的獨立預後因素.
목적 분석신세포암환자술후장기생존정황급기상관예후인소. 방법 대국내4가의원비뇨외과2000-2008년수술치료적1 544례비전이성신세포암진행회고성분석,수집병통계기장기수방생존정황급기여성별、년령、종류조직학류형、분급、분기、림파결전이정황、수술방식등가능적예후인소적관계. 결과 1 544례중,남1 041례(67.4％),녀503례(32.6％).종류최대경(5.4±3.1)cm,중위수4.7 cm.투명세포암1 371례(88.8％),유두상암89례(5.8％),혐색세포암44례(2.8％),집합관암4례(0.3％),기타미분류신암36례(2.3％).Fuhrman분급Ⅰ급322례(24.8％),Ⅱ급791례(60.8％),Ⅲ급168례(12.9％),Ⅳ급20례(1.5％).근거2010년AJCC TNM표준분기,pT1기1 162례(75.3％),pT2기247례(16.0％),pT3기103례(6.7％),pT4기24례(1.6％);림파결정황N0l 491례(96.6％),N153례(3.4％).1 544례총체수방솔93.4％,평균수방시간(59.8±23.3)개월,1、3、5년생존솔분별위98.2％、93.4％화89.4％.3충조직학아형(투명세포암、유두상암、혐색세포암)간비교,생존솔차이무통계학의의(P=0.935),기5년생존솔분별위90.1％、85.8％、89.6％.Fuhrman Ⅰ～Ⅳ급5년생존솔분별위93.6％、91.1％、84.2％、36.5％;T1～ T4종류5년생존솔분별위93.5％、84.5％、60.7％、70.0％;림파결음성자5년생존솔위91.3％,림파결전이자위37.1％.Fuhrman분급(P=0.000)、T분기(P=0.000)、림파결전이(P=0.000)시신암수술후예후적영향인소.다인소분석결과현시,년령≥55세、고급별종류(FuhrmanⅢ～Ⅳ급)、종류대소、종류분기체T3화림파결전이위영향신암수술후예후적독립위험인소,성별、종류측별、수술방식불시영향예후적독립위험인소. 결론 대비전이신세포암술후환자,년령、종류대소、분급、분기화림파결전이정황시5년총체생존적독립예후인소.
Objective To analyze long-term survival of renal cell carcinoma (RCC) after surgery and its prognostic factors.Methods A total of 1 544 non-metastatic RCCs who underwent surgery from 2000 to 2008 in 4 medical centers in China were enrolled.The long-term survival information as well as possible prognostic factors,including age,sex,tumor histologic subtype,grading,staging,lymph node metastasis,type of surgery,etc.,were collected and analyzed.Results Of all the 1 544 patients,1 041 were male and 503 were female.The average size of lesion was 5.4±3.1 cm,with median at 4.7 cm.Histologic subtype was clear cell RCC in 1 371 (88.8％),papillary in 89 (5.8％),chromophobe in 44 (2.8％),collecting duct in 4 (0.3％) and other subtypes in 36 (2.3％).Fuhrman grading was Ⅰ in 322 (24.8％),Ⅱ in 791 (60.8％),Ⅲ in 168 (12.9％) and Ⅳ in 20 (1.5％).Tumor staging according to 2010 AJCC TNM staging system was pT1 in 1 162 (75.3％),pT2 in 247 (16.0％),pT3 in 103 (6.7％) and pT4 in 24 (1.6％).Lymph node metastasis was negative in 1 491 (96.6％),positive in 53 (3.4％).The overall follow-up rate was 93.4％ with a median follow-up time of 59.8±23.3 months.The 1-year,3-year and 5-year overall survival rate was 98.2％,93.4％ and 89.4％.There was no significant difference among the three main histologic subtypes (P=0.935).The 5-year overall survival for clear cell,papillary and chromophobe RCC was 90.1％,85.8％ and 89.6％,respectively.The 5-year overall survival for Fuhrman Ⅰ to Ⅳ was 93.6％,91.1％,84.2％ and 36.5％,respectively.The 5-year overall survival for pT1,pT2,pT3 and pT4 was 93.5％,84.5％,60.7％ and 70.0％,respectively.Patients with no lymph node metastasis had a 5-year overall survival of 91.3％,significantly higher than that of patients with lymph node metastasis (37.1％).Fuhrman grading,T staging and lymph node metastasis were significant prognostic factors in Log-rank test.In the multivariate analysis,age ≥ 55 years,high grade (Fuhrman Ⅲ-Ⅳ) tumors,tumor size,tumor staging over T3 and lymph node metastasis were independent prognostic factors,while sex,side of tumor and type of surgery were not.Conclusion In non-metastatic RCC receiving surgical therapy,age,tumor size,grading,staging and lymph node metastasis are independent prognostic factors for 5-year overall survival.
