非转移性肾癌患者术后Nomogram预后模型的研究  

The establishment of Nomogram prognostic model for patients with non-metastasis renal cell carcinoma after the operation

作　　者：沈洪亮[1] 王旭东[1] 李明义[1] 王宁[1] 安勇[1] 吉正国[1] 时淑舫[2] 张淑红[2] 杨培谦[1] 田野[1] Shen Hongliang;Wang Xudong;Li Mingyi;Wang Ning;An Yong;Ji Zhengguo;Shi Shufang;Zhang Shuhong;Yang Peiqian;Tian Ye(Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China)

机构地区：[1]首都医科大学附属北京友谊医院泌尿外科,100050 [2]首都医科大学附属北京友谊医院病理科,100050

出　　处：《中华泌尿外科杂志》2018年第4期245-250,共6页Chinese Journal of Urology

基　　金：北京市科委首都市民健康项目培育（Z131100006813015）

摘　　要：目的探讨非转移性肾癌患者术后生存因素，构建肾癌Nomogram预后模型。方法回顾性分析2008年1月至2012年12月我院手术治疗的580例非转移性肾癌患者的临床资料。男392例，女188例。年龄24～86岁，平均56岁。右肾癌268例，左肾癌312例。肿瘤直径1.5～17.5 cm，平均4.8cm。对病理结果复核，并构建组织芯片，进行免疫组化分析。对所有患者进行随访，记录生存时间、肿瘤有无复发、术后治疗及转归，确定患者总生存（OS）、肿瘤特异性生存（CSS）及肿瘤无进展生存（PFS）时间。对患者资料进行单因素、多因素分析及生存分析，筛选出与患者不同随访终点密切相关的独立预后因子；建立肾癌患者Nomogram预后模型，并进行靴值分析、内部验证。结果本组580例中，514例（88.6%）行腹腔镜手术，66例（11.4%）行开放手术；160例（27.6%）行保留肾单位手术，420例（72.4%）行根治性肾切除术。病理诊断：透明细胞癌468例（80.7%），乳头状细胞癌56例（9.7%），嫌色细胞癌32例（5.5%），其他亚型细胞癌24例（4.1%）；病理分期Ⅰ期442例（76.2%），Ⅱ期88例（15.2%），Ⅲ期48例（8.3%），Ⅳ期2例（0.3%）。碳酸酐酶9（CA9）高表达424例（73.1%），低表达156例（26.9%）。中位随访时间66个月（4～82个月），失访率7.1%（41/580）；206例死亡，其中166例为肿瘤特异性死亡。本组患者3年和5年OS率、CSS率及PFS率分别为83.4%、88.2%、72.4%和69.6%、73.0%、55.8%。多因素分析结果显示，与患者生存密切相关的独立预后因子分别是肿瘤病理亚型、肿瘤分期、肿瘤直径及CA9表达。依据以上4个指标建立Nomogram预后模型；内部验证模型OS、CSS及PFS的一致性指数分别为0.72（95%CI 0.69～0.75）、0.77（95%CI 0.74～0.81）、0.79（95%CI 0.76～0.83）。结论肿瘤病理亚型、肿瘤分期、肿瘤直径及CA9是非转移性肾癌患者术后的�ObjectiveTo investigate the prognostic factors of renal cell carcinoma and to establish a prognostic model for patients with non-metastasis renal cell carcinoma （RCC） after operation.MethodsWe retrospectively reviewed the clinical data of patients with RCC who underwent radical or partial nephrectomy from January 2008 to December 2012, including 392 males （67.6%） and 188 females （32.4%）, with an average age of 56 years（range 24-86 years）. The average diameter of tumor was 4.8 cm （range 1.5-17.5 cm）. The pathological slides of tumor tissue were reviewed by pathologist, and the tissue microarray （TMA） were constructed. The immunohistochemical staining of TMA were carried out. All patients were followed up the prognosis information of the overall survival （OS）, cancer specific survival （CSS） and progression free survival （PFS）. Based on these data, univariate and multivariate analysis and survival analysis were performed. Independent prognostic factors related to different follow-up endpoints of patients were screened out. A Nomogram prognostic model for RCC was established and verified. Internal validation were performed by boots value analysis.ResultsAmong 580 cases, 160 cases （27.6%） accepted nephron sparing surgery and 420 cases （72.4%） radical nephrectomy, included 514 cases （88.6%） of laparoscopic surgery and 66 cases （11.4%） of open surgery. There were 468 cases of clear cell carcinoma （80.7%）, 56 cases of papillary carcinoma （9.7%）, 32 cases of chromophobe cell carcinoma （5.5%）, 24 patients with other subtypes of cancer cells （4.1%）. In pathological staging, stage Ⅰ, Ⅱ, Ⅲ, Ⅳ were 442 cases （76.2%）, 88 cases （15.2%）, 48 cases （8.3%）, 2 cases （0.3%）, respectively. There were 424 cases （73.1%） with high expression of CA9 , and 156 cases （26.9%） with low expression . The median follow-up was 66 （4-82） months, and 41 cases （7.1%） were lost of follow-up. For 3 and 5 years, OS, CSS and PFS were 83.4%, 88.2%,

关 键 词：癌 肾细胞 预后因素 预后模型 Nomogram模型 

分 类 号：R737.11[医药卫生—肿瘤]