肾癌cM0(i+)分期诊断标准建立及临床意义的单中心研究  

Establishment of a diagnostic standard for renal cell carcinoma cM0(i+)category and its clinical significance:a single center study

作　　者：王振龙[1] 薛玉泉[1] 管翊冰 张鹏[1] 张亚萍[1] 杨小杰[1] 薛力[1] 李和程[1] 李洪亮[1] 种铁[1] WANG Zhen-long;XUE Yu-quan;GUAN Yi-bing;ZHANG Peng;ZHANG Ya-ping;YANG Xiao-jie;XUE Li;LI He-cheng;LI Hong-liang;CHONG Tie(Department of Urology,The Second Affiliated Hospital of Xi an Jiaotong University,Xi an 710004,China)

机构地区：[1]西安交通大学第二附属医院泌尿外科,陕西西安710004

出　　处：《现代泌尿外科杂志》2020年第12期1058-1063,共6页Journal of Modern Urology

基　　金：西安市科技计划项目(No.201805096YX4SF30)。

摘　　要：目的建立单中心"cM0(i+)期肾癌诊断标准"并探讨其临床意义。方法回顾2015年1月至2019年1月在西安交通大学第二附属医院诊治的接受循环肿瘤细胞(CTCs)分型检测的131例肾癌患者的临床资料。记录术前患者一般状况、肿瘤学特征等信息。术前及术后2年内每3个月进行CTCs分型检测,影像学及常规、生化检查,随访复发、转移情况。按术前及术后CTCs总数≥6或<6,间质型循环肿瘤细胞(MCTCs)数≥1或<1,CTCs及MCTCs变化趋势分组,分析其与肿瘤进展的相关性。结果纳入肾癌患者131例,通过单因素及Cox回归分析,发现了术后CTCs总数≥6,术后MCTCs≥1,CTCs总数或MCTCs进展趋势与肾癌进展有显著相关性(P<0.01),风险比分别为HR=5.69、3.12、2.81、2.93。依据cM0(i+)期肾癌诊断标准,cM0(i+)期患者的无进展生存期(PFS)较非cM0(i+)期患者显著缩短[(37.952±4.977)vs.(55.241±1.568)个月,P=0.004]。结论建立了单中心cM0(i+)期肾癌诊断标准,要求同时满足以下3项:①术后CTCs总数CTCs≥6;②术后MCTCs≥1;③CTCs总数或MCTCs呈进展趋势。发现了肾癌cM0(i+)分期与肿瘤进展的显著相关性,初步证实了该诊断标准对于高转移风险M0期肾癌患者良好的评估和筛选作用。Objective To establish the diagnostic standard for renal cell carcinoma(RCC)cM0(i+)category in our hospital and to discuss its clinical significance.Methods The clinical data of 131 RCC cases undergoing circulating tumor cells(CTCs)typing in our hospital during Jan.2015 and Jan.2019 were retrospectively analyzed.The general condition and oncological characteristics of patients before operation were recorded.Before operation and every 3 months after operation,CTCs typing,imaging,routine and biochemical examinations were performed,and the recurrence and metastasis were followed up.Patients were divided into groups according to CTCs≥6 or<6,mesenchymal CTCs(MCTCs)≥1 or<1,and trends of CTCs and MCTCs.The correlation between CTCs and tumor progression was analyzed.Results The univariate analysis and Cox regression analysis showed postoperative CTCs≥6,postoperative MCTCs≥1,total number of CTCs and MCTCs trend were significantly related to the progression of RCC(P<0.01,HR=5.69,3.12,2.81,2.93).According to the diagnostic standard of cM0(i+)category,the progression-free survival(PFS)of cM0(i+)patients was significantly shorter than that of non cM0(i+)patients[(37.952±4.977)vs.(55.241±1.568)months,P=0.004].Conclusion The diagnostic standard of RCC cM0(i+)category in the Second Affiliated Hospital of Xi’an Jiaotong University was established,and the following 3 items were met simultaneously:the total number of postoperative CTCs≥6;postoperative MCTCs≥1;the total number of CTCs or MCTCs was progressive.There is significant correlation between cM0(i+)staging and cancer progression.It is preliminarily confirmed that the diagnostic standard of cM0(i+)category has a good evaluation and screening effect on patients with stage M0 renal cancer with high metastasis risk.

关 键 词：肾细胞癌 循环肿瘤细胞 cM0(i+)分期 

分 类 号：R737.1[医药卫生—肿瘤]