成人肾非透明细胞癌的预后影响因素分析  

Survival and prognostic analysis of adult nonclear cell renal cell carcinoma

作　　者：余永波 张铭鑫 任远中 范中元 王丽萍[2] 梁晔[2] 牛海涛[2] Yu Yongbo;Zhang Mingxin;Ren Yuanzhong;Fan Zhongyuan;Wang Liping;Liang Ye;Niu Haitao(Department of Clinical Medicine,Qingdao University,Department of Urology,the Affiliated Hospital of Qingdao University,Qingdao 266071,China;Department of Urology,the Affiliated Hospital of Qingdao University,Qingdao 266071,China)

机构地区：[1]青岛大学临床医学部青岛大学附属医院泌尿外科,266071 [2]青岛大学附属医院泌尿外科,266071

出　　处：《中华泌尿外科杂志》2019年第9期654-660,共7页Chinese Journal of Urology

摘　　要：目的探讨成人肾非透明细胞癌预后的影响因素.方法回顾性分析2012年1月至2019年1月青岛大学附属医院286例行保留肾单位手术或根治性肾切除术,术后病理诊断为原发性肾非透明细胞癌患者的临床、病理资料及随访情况.男159例,女127例.年龄17 ~81岁,平均53岁.AJCC分期:Ⅰ期218例,Ⅱ期56例,Ⅲ期9例,Ⅳ期3例.实验室检查:淋巴细胞百分比(31.5±10.5)%,中性粒细胞淋巴细胞比值(NLR)(2.6±2.8),白蛋白(40.9 ±4.7) g/L,前白蛋白(255.0±74.3) mg/L,乳酸脱氢酶(LDH)(201.0±174.0) U/L,肌酸激酶同工酶(CK-MB)(20.0±62.1)U/L,总胆固醇(4.9±1.0) mmol/L,尿素氮血肌酐比值(BUN/Cr)(12.9±9.9),血糖(5.4±1.3) mmol/L,甘油三酯(1.4±1.1) mmo]/L,低密度脂蛋白(LDL-C)(2.9±0.8) mmol/L.采用受试者工作特征曲线(ROC)确定以上指标的界值,并根据界值分为高于界值组和低于界值组,比较两组指标的差异.采用单因素和多因素Cox回归分析与成人肾非透明细胞癌及其亚型预后相关的影响因素.Kaplan-Meier法绘制患者生存曲线,采用log-rank检验比较两组的生存率差异,分析影响预后的相关因素.采用相同方法分析肾嫌色细胞癌和乳头状肾细胞癌两个亚组的预后因素.结果本研究286例,术后随访1 ~ 87个月,平均43.9个月,死亡26例,其余均无瘤生存.3年和5年生存率分别为93.8%和89.3%.Cox单因素和多因素分析结果显示,AJCC分期(HR =2.38,95% CI1.48 ~ 3.83)、LDH(HR=2.99,95% CI1.16 ~7.69)、血糖(HR =4.13,95% CI1.74 ~9.78)、CK-MB(HR=3.85,95% CI1.63 ~9.08)是肾非透明细胞癌预后的独立影响因素.NLR(HR=8.28,95% CI1.66 ~41.35)和LDH(HR=9.82,95% CI2.94 ~ 32.82)分别为肾嫌色细胞癌和乳头状肾细胞癌预后的独立影响因素.结论 AJCC分期、LDH、血糖、CK-MB为成人肾非透明细胞癌预后的独立影响因素,AJCC分期早、低LDH、低血糖、低CK-MB的患者预后更好.NLR为肾嫌色细胞癌预后的独立影响因素,低NLR患者预后好.LDH为乳�Objective To analyze the prognostic factors of adult nonclear cell renal cell carcinoma (nccRCC). Methods The clinical data of 286 patients with pathologically diagnosed one specific type of nccRCC after radical nephrectomy and nephron sparing surgery(NSS) in the affiliated hospital of Qingdao university followed up from January 2012 to January 2019 were retrospectively analyzed.There were 159 males and 127 females. Their age ranged from 17 to 81 years old, with an average age of 53. Based on the AJCC combination stage, 218 cases were in stage Ⅰ, 56 cases were in stage Ⅱ, 9 cases were in stage Ⅲ, 3 cases were in stage Ⅳ. Assay indicators were collected, including lymphocyte percentage(LY%)(31.5±10.5), neutrophil-lymphocyte ratio(NLR)(2.6±2.8), albumin(40.9±4.7)g/L, prealbumin(255.0±74.3)mg/L, lactate dehydrogenase (LDH)(201.0±174.0)U/L, creatine kinase isoenzyme (CK-MB)(20.0±62.1)U/L, total cholesterol(4.9±1.0)mmol/L, blood urea nitrogen/creatinine (BUN/Cr)(12.9±9.9), blood glucose(5.4±1.3)mmol/L, triglyceride(1.4±1.1)mmol/L, low-density lipoprotein cholesterol (LDL-C)(2.9±0.8)mmol/L. The optimal cut-off value of the above indexes were obtained by the receiver operating characteristic curve(ROC) in the SPSS software, and difference between high cut-off and low cut-off divided basing on the optimal cut-off value were evaluated respectively. The prognostic factors of adult nccRCC were evaluated by univariate and multivariate Cox proportional hazards regression analysis. Kaplan-Meier survival curve was used to study the survival relationship. The log-rank test were used to compare survival rate in two groups. The prognostic factors of nccRCC were analyzed after the results above were presented. Prognostic factors in renal chromophobe cell carcinoma and papillary cell carcinoma were analyzed by the same method. Results The 286patients were followed up from 1 to 87 months, with an average of 43.9 months. The 3-year and 5-year survival rates were 93.8% and 89.3%, respectively. Results of univariate a

关 键 词：肾肿瘤 肾非透明细胞癌 病理 预后 

分 类 号：R737.11[医药卫生—肿瘤]