乳头状肾细胞癌的临床病理特征及预后分析  

Clinicopathological features and prognosis in patients with papillary renal cell carcinoma

作　　者：洪保安 侯惠民[2] 陈凌霄 李智[3] 张志鹏[2] 杜鑫 李源[3] 刘明[2] 张宁[1] Hong Baoan;Hou Huimin;Chen Lingxiao;Li Zhi;Zhang Zhipeng;Du Xin;Li Yuan;Liu Ming;Zhang Ning(Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing),Department of Urology,Peking University Cancer Hospital&Institute,Beijing 100142,China;Department of Urology,Beijing Hospital,Beijing 100730,China;Department of Urology,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所泌尿外科恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142 [2]北京医院泌尿外科,北京100730 [3]中南大学湘雅医院泌尿外科,长沙410008

出　　处：《中华泌尿外科杂志》2020年第12期896-900,共5页Chinese Journal of Urology

基　　金：首都特色应用研究项目(Z171100001017201);首都卫生发展科研专项(2020-2-1024)。

摘　　要：目的:探讨乳头状肾细胞癌(pRCC)的临床病理特征及预后相关因素。方法:回顾性分析2012年1月至2019年10月收治的117例pRCC患者的临床病理资料,其中北京大学肿瘤医院40例、北京医院24例、中南大学湘雅医院53例。男88例,女29例。平均年龄53(21~82)岁。肿瘤位于左肾57例,右肾60例。50例行肾部分切除术,67例行根治性肾切除术。采用Kaplan-Meier法绘制无进展生存曲线并通过log-rank检验分析。应用Cox模型进行单因素和多因素分析,明确影响pRCC患者无进展生存率的相关因素。结果:本组117例,肿瘤最大径平均5.6(0.8~15.0)cm。pRCC分型1型29例,2型88例。术后病理分期:pT 1期74例(63.2%),pT 2期19例(16.2%),pT 3期14例(12.0%),pT 4期10例(8.5%)。WHO/ISUP病理分级:Ⅰ级11例(9.4%),Ⅱ级49例(41.9%),Ⅲ级45例(38.5%),Ⅳ级12例(10.3%)。脉管癌栓阳性19例(16.2%)。肿瘤坏死阳性32例(27.4%)。总体患者术后中位随访时间24个月,生存分析结果显示3年无进展生存率为79.9%。1型和2型pRCC患者术后中位随访时间分别为43个月和17个月,3年无进展生存率分别为96.6%和72.1%,1型pRCC患者的预后明显优于2型(P=0.025)。单因素分析结果显示肿瘤大小(HR=3.302,95%CI1.190~9.160,P=0.022)、手术方式(HR=10.600,95%CI1.399~80.344,P=0.022)、病理分期(HR=7.840,95%CI2.716~22.628,P=0.000)、脉管癌栓(HR=7.116,95%CI2.616~19.358,P=0.000)和肿瘤坏死(HR=3.021,95%CI1.127~8.095,P=0.028)与2型pRCC患者的预后密切相关(P<0.05)。多因素分析未发现影响2型pRCC患者无进展生存率的独立预后因素。分层分析结果显示,pT 1期2型pRCC患者接受肾部分切除术与根治手术的无进展生存率差异无统计学意义(P=0.230)。结论:2型pRCC较1型更常见。与1型pRCC相比,2型患者肿瘤pT分期更晚且病理分级更高。对于pT 1期的2型pRCC,肾部分切除术的效果不劣于根治性手术,可考虑行保留肾单位手术。Objective To investigate the clinicopathological features and prognostic factors of papillary renal cell carcinoma(pRCC).Methods The clinicopathological features of 117 pRCC patients admitted from January 2012 to October 2019 were retrospectively analyzed,including 40 cases from Peking University Cancer Hospital,24 cases from Beijing Hospital,and 53 cases from Xiangya Hospital of Central South University.There were 88 male and 29 female patients included in this study,with a mean age of 53(ranging from 21-82).Fifty-seven tumors were located in the left kidney and 60 in the right kidney.Fifty cases underwent partial nephrectomy and 67 cases underwent radical nephrectomy.Kaplan-Meier curve and log-rank test were used to describe the progression-free survival(PFS).Cox regression model was used for univariate and multivariate analysis to identify the prognostic factors.Results Of the 117 patients,the largest tumor diameter was 0.8 to 15.0 cm,with an average of 5.6 cm.There were 29 patients with type 1 pRCC and 88 patients with type 2.Postoperative pathological staging showed 74 cases(63.2%)of pT1 stage,19 cases(16.2%)of pT2 stage,14 cases(12.0%)of pT3 stage,and 10 cases(8.5%)of pT4 stage.WHO/ISUP pathological classification showed 11 cases(9.4%)of gradeⅠ,49 cases(41.9%)of gradeⅡ,45 cases(38.5%)of gradeⅢ,and 12 cases(10.3%)of gradeⅣ.Nineteen cases(16.2%)were positive for vascular cancer embolus.There were 32 cases(27.4%)with positive tumor necrosis.The overall follow-up was 24 months.Survival analysis showed that the 3-year PFS rate was 79.9%.The median follow-up time for 29 patients with type 1 pRCC was 43 months,and the 3-year PFS rate was 96.6%.The median follow-up for 88 patients with type 2 pRCC was 17 months,and the 3-year PFS rate was 72.1%.The prognosis of patients with type 1 pRCC was significantly better than that of type 2(P=0.025).Univariate analysis showed that tumor size,surgical procedure,pT staging,vascular cancer embolus and tumor necrosis were closely related to the prognosis of patients with

关 键 词：癌 肾细胞 乳头状肾细胞癌 临床特征 病理特征 预后 

分 类 号：R737.11[医药卫生—肿瘤]