3～4期慢性肾脏病对肾癌术后患者的预后影响分析  

Prognostic outcomes and risk factors of renal cell carcinoma with chronic kidney disease of stage Ⅲ-Ⅳ

作　　者：贾卓[1] 巩艳青[1] 张崔建[1] 唐世英 唐琦[1] 彭鼎[1] 张雷[1] 杨恺惟[1] 李学松[1] 何志嵩[1] 周利群[1] JIA Zhuo,GONG Yanqing,ZHANG Cuijian,TANG Shiying,TANG Qi,PENG Ding,ZHANG Lei,YANG Kaiwei,LI Xuesong,HE Zhisong,ZHOU Liqun(Department of Urology,Peking University First Hospital,Institute of Urology,Peking University,National Urological Cancer Center,Urogenital Diseases（Male）Molecular Diagnosis and Treatment Center,Beijing, 100034, China)

机构地区：[1]北京大学第一医院泌尿外科北京大学泌尿外科研究所国家泌尿男生殖系肿瘤研究中心,北京100034

出　　处：《临床泌尿外科杂志》2018年第10期806-811,共6页Journal of Clinical Urology

摘　　要：目的:分析患有3～4期慢性肾脏病(CKD)的肾癌患者术后的预后状况及其影响因素。方法:回顾性分析2002年1月～2010年12月病理证实的1 353例肾癌患者的临床资料,根据患者术前肾小球滤过率(eGFR)水平,将eGFR≥60ml·min^(-1)·(1.73m^2)^(-1)(1～2期CKD)的1 182例患者设为对照组,将15ml·min^(-1)·(1.73m^2)^(-1)≤eGFR<60ml·min^(-1)·(1.73m^2)^(-1)(3～4期CKD)的171例患者设为试验组,比较两组患者临床资料和预后情况。结果:试验组患者中位年龄55(25～84)岁,对照组中位年龄55(24～87)岁。男性患者试验组110例(64.3%),对照组837例(70.8%)。两组BMI、高血压病、糖尿病比较差异无统计学意义(P>0.05)。试验组eGFR显著低于对照组[(50.77±8.49)ml·min^(-1)·(1.73m^2)^(-1) vs.(92.00±34.65)ml·min^(-1)·(1.73m^2)^(-1),P<0.01]。试验组行肾根治性切除术患者明显多于对照组(85.4%vs.76.1%,P<0.01)。试验组和对照组5年肿瘤特异性生存率(CSS)分别为91.2%和89.1%(P=0.171),5年总体生存率(OS)分别为89.3%和87.4%,两组比较差异无统计学意义(P>0.05)。多因素分析中,eGFR<60ml·min^(-1)·(1.73m^2)^(-1)均不是影响CSS或OS的独立危险因素。结论:本研究单因素及多因素分析显示术前存在3～4期CKD并不影响肾癌患者的预后。Objective：To explore prognostic outcomes and risk factors of renal cell carcinoma（RCC）with chronic kidney disease（CKD）of stageⅢ-Ⅳ.Method：We performed a retrospective analysis of 1353 patients with RCC confirmed by pathology.The patients were classified as experimental group and control group according to eGFR≥60 ml·min-1·（1.73 m2）-1 or between 15 and 60 ml·min-1·（1.73 m2）-1.Clinicopathologic outcomes were evaluated and cancer specific survival（CSS）and overall survival（OS）were assessed by Kaplan-Meier method and Cox regression.Result：There were 171 patients in experimental group and 1182 patients in control group.The median age in experimental and control groups were 55（range,25-84）and 55（range,24-87）years old respectively.There were 110（64.3%）males in experimental group,while 837（70.8%）in control group.There was no statistical significance in BMI（P〉0.05）,rate of patients with hypertension（P=0.832）or diabetes（P=0.193）between two groups.The eGFR in experimental group was lower than that in control（50.77±8.49 ml·min-1·1.73 m2 vs.92.00±34.65 ml·min-1·1.73 m2,P〈0.01）.In experimental group 85.4%of patients and in control group 76.1% of patients underwent nephrectomy（P 〈0.01）.The five-year CSS after surgery was91.2%in experimental group and 89.1%in control group（P〉0.05）.The five-year OS was 89.3%in experimental group and 87.4%in control group（P〉0.05）with no statistical significance.In multivariable analysis,eGFR〈60 ml·min-1·（1.73 m2）-1 was not the factor that could predict CSS or OS.Conclusion：CKD of stage Ⅲ-Ⅳ was not the factor that could influence the prognostic outcomes in patients with RCC.

关 键 词：肾癌 慢性肾脏病 手术治疗 预后 

分 类 号：R737.11[医药卫生—肿瘤]