手术治疗局限性透明细胞肾细胞癌的临床和病理因素的预后价值
Prognostic value of clinical and pathological factors for surgically treated localized clear cell renal cell carcinoma.
作者信息
Teng Jingfei, Gao Yi, Chen Ming, Wang Kai, Cui Xingang, Liu Yushan, Xu Danfeng
机构信息
Department of Urology, General Hospital of Beijing Military Command, Beijing 100700, China.
Department of Urology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.
出版信息
Chin Med J (Engl). 2014;127(9):1640-4.
BACKGROUND
Surgical resection is the most effective treatment for renal cell carcinoma (RCC). Currently several prognostic factors and models are used for outcome prediction. However, whether intratumoral changes are independent prognostic factors for RCC or not remains unclear. The aim of the study was to investigate the prognostic roles of intratumoral changes in surgical treated localized clear cell renal cell carcinoma (ccRCC).
METHODS
Patients who received partial or radical nephrectomy between 2004 and 2009 in our center were retrospectively reviewed. Univariate and multivariate analyses were used to assess gender, age, body mass index (BMI), intratumoral hemorrhage, tumor necrosis, cystic degeneration, sarcomatoid change, Ki-67 expression, Fuhrman grade, and T stage on recurrence-free survival (RFS) and cancer-specific survival (CSS).
RESULTS
A total of 378 patients were included in our study. In univariate analysis, age, BMI, intratumoral hemorrhage, tumor necrosis, sarcomatoid change, Ki-67 expression level, Fuhrman grade, and T stage were prognostic factors for RFS. Age, BMI, tumor necrosis, sarcomatoid change, Ki-67 expression level, Fuhrman grade, and T stage were prognostic factors effecting CSS. In multivariate analysis, age, BMI, tumor necrosis, sarcomatoid change, Ki-67, Fuhrman grade, and T stage were independent prognostic factors for both RFS and CSS.
CONCLUSION
Intratumoral changes such as tumor necrosis and sarcomatoid change are independent prognostic factors for ccRCC.
背景
手术切除是肾细胞癌（RCC）最有效的治疗方法。目前有多种预后因素和模型用于预测预后。然而，肿瘤内变化是否为RCC的独立预后因素仍不清楚。本研究的目的是探讨肿瘤内变化在手术治疗局限性透明细胞肾细胞癌（ccRCC）中的预后作用。
方法
回顾性分析2004年至2009年在本中心接受部分或根治性肾切除术的患者。采用单因素和多因素分析评估性别、年龄、体重指数（BMI）、肿瘤内出血、肿瘤坏死、囊性变、肉瘤样变、Ki-67表达、Fuhrman分级和T分期对无复发生存期（RFS）和癌症特异性生存期（CSS）的影响。
结果
本研究共纳入378例患者。单因素分析中，年龄、BMI、肿瘤内出血、肿瘤坏死、肉瘤样变、Ki-67表达水平、Fuhrman分级和T分期是RFS的预后因素。年龄、BMI、肿瘤坏死、肉瘤样变、Ki-67表达水平、Fuhrman分级和T分期是影响CSS的预后因素。多因素分析中，年龄、BMI、肿瘤坏死、肉瘤样变、Ki-67、Fuhrman分级和T分期是RFS和CSS的独立预后因素。
结论
肿瘤坏死和肉瘤样变等肿瘤内变化是ccRCC的独立预后因素。
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