肾细胞癌骨转移的临床特征及主要预后因素分析  

Clinical features and prognostic factors of kidney cancer patients with bone metastases

作　　者：何健[1] 曾昭冲[1] 杨平[1] 陈兵[1] 姜威[1] 

机构地区：[1]复旦大学附属中山医院放疗科,上海200032

出　　处：《肿瘤》2010年第8期687-690,共4页Tumor

摘　　要：目的:探讨肾细胞癌骨转移患者的临床特征及其预后因素。方法:收集1997年1月-2007年1月在本院接受诊治的45例肾细胞癌骨转移患者的临床资料进行回顾性分析。对患者的年龄、性别、原发灶大小、原发灶是否手术、是否放疗、骨转移灶数目、骨转移时血清碱性磷酸酶(alkaline phosphatase,ALP)水平、是否伴骨旁软组织转移、淋巴结转移以及其他脏器转移等多项因素进行预后分析。采用Kaplan-Meier法计算生存率,log-rank法进行单因素分析,COX模型进行多因素分析。结果:肾细胞癌骨转移患者的1、2和3年生存率分别为54.0%、26.0%和17.3%,中位生存期为(14.0±1.8)个月。单因素分析结果显示,血清ALP水平≤150u/L组与>150u/L组的生存率差异有统计学意义(P=0.001),其余各因素无统计学意义。COX模型多因素分析结果显示,骨转移时的血清ALP水平、是否伴有其他脏器转移以及骨转移时是否伴淋巴结转移等是影响预后的因素。结论:肾细胞癌骨转移患者预后较差,血清ALP水平、是否伴其他脏器转移及淋巴结转移等因素是独立的预后因素,可为临床选择合适的放疗分割计划及放疗剂量提供依据。Objective：To identify the clinical features and prognostic factors of kidney cancer patients with bone metastases. Methods ： We retrospectively analyzed the data from 45 kidney cancer patients with bone metastases who were treated in our hospital be- tween Jan 1997 and Jan 2007. Multiple prognostic factors were analyzed such as age, gender, tumor size, resection of primary lesions, radiation of primary lesions, number of bone lesions, serum alkaline phosphatase （ALP） level, parenehyma metastases, lymph node metastases, and normal organ metastases. Survival time was calculated by using the Kaplan-Meier method. Univariate analysis was performed using log-rank method and multivariate analysis was conducted using COX regression model. Results： The 1-, 2-, and 3-year survival rates were 54.0% , 26.0% and 17.3% respectively for kidney cancer patients with bone metastasis and the median survival time was （ 14.0 ± 1.8 ） months. Univariate analysis showed that there was significant difference in the survival rate between serum ALP level ≤ 150 u/L and 〉 150 u/L group （P =0. 001 ）. Other parameters had no prognostic value. COX multivariate analysis showed that serum ALP levels at the time of bone metastasis, normal organ or lymph node metastases were independent prognostic factors. Conclusion： The kidney cancer patients with bone metastases has poor prognosis. The serum ALP level, normal organ metastases or lymph node metastases were independent prognostic factors. These prognostic factors will help to determine the appropriate plan and dose of fractionated radiotherapy.

关 键 词：癌 肾细胞 肿瘤转移 骨转移 预后 

分 类 号：R737.11[医药卫生—肿瘤]