肾细胞癌不同病理组织亚型与预后的关系  

Comparison of the prognosis of subgroup of renal cell carcinoma of different pathological types

作　　者：邵彦翔 窦卫超 胡旭[1] 任尚青 杨振[3] Lia Thongher 刘健帮 熊三钞 杨为潇 魏强[1] 曾浩[1] 李响[1] Shao Yanxiang;Dou Weichao;Hu Xu;Ren Shangqing;Yang Zhen;Lia Thongher;Liu Jianbang;Xiong Sanchao;Yang Weixiao;Wei Qiang;Zeng Hao;Li Xiang(Department of Urology,West China Hospital,Sichuan University,Chengdu 610041,China;Robot Minimally Invasive Center,Sichuan Provincial People’s Hospital,Chengdu 610072,China;Department of Urology,Chengdu Second People’s Hospital,Chengdu 610017,China)

机构地区：[1]四川大学华西医院泌尿外科,成都610041 [2]四川省人民医院机器人微创中心,成都610072 [3]成都市第二人民医院泌尿外科,成都610017

出　　处：《中华泌尿外科杂志》2021年第2期89-96,共8页Chinese Journal of Urology

摘　　要：目的探讨肾癌术后病理组织分型对预后的影响。方法回顾性分析华西医院2002年7月至2014年6月行手术治疗的1346例肾癌患者的临床病理资料,男839例,女507例;术时年龄(55.1±13.4)岁;美国东部肿瘤协作组(ECOG)评分0分911例,≥1分435例;透明细胞癌1120例,乳头状细胞癌62例,嫌色细胞癌79例,其他类型肾癌85例;T1、T2、T3、T4期分别为1019、177、102、48例;WHO核分级高、中、低分化及未知分别为587、530、85、144例;肿瘤直径<5、≥5且<10、≥10 cm及未知分别为685、541、104、16例;合并坏死200例;合并肉瘤样分化27例。同时收集2000—2017年SEER数据库中80439例肾癌术后病例的资料,男51371例,女29068例;年龄(60.9±12.4)岁;白色人种66261例,黑色人种8680例,亚裔及北美原住民5022例,未知人种476例;透明细胞癌62600例,乳头状细胞癌12170例,嫌色细胞癌4354例,其他类型肾癌1315例;T1、T2、T3、T4期分别为55332、8687、15516、904例;WHO核分级高、中、低分化分别为52323、22700、5416例;肿瘤直径<5、≥5且<10、≥10 cm分别为46741、25760、7938例。分别分析华西医院和SEER两组人群中性别、年龄等临床因素以及肿瘤组织亚型、分期、分级等病理因素对预后的影响;在SEER不同人种中进行亚组分析,了解不同组织亚型肾癌术后的预后差异,并与华西医院病例进行比较;将华西医院病例带入UISS、SSIGN、Leibovich 3种肾癌预后预测模型,通过一致性指数(c-index)分析不同模型对华西医院病例及亚组的预测价值。结果华西医院病例1346例生存分析结果显示,嫌色细胞癌、透明细胞癌、乳头状细胞癌、其他类型肾癌的5年总生存率分别为97.5%、87.9%、79.7%、68.4%;术时年龄>50岁、ECOG评分≥1分、肿瘤分期偏晚、核分级差、肿瘤直径大、合并坏死及肉瘤样分化均提示预后不佳(P<0.05)。SEER数据库80439例生存分析结果显示,嫌色细胞癌、乳头状细胞癌、透Objective To study and compare the prognosis of different pathological subtypes of renal cell carcinoma(RCC).Methods Clinicopathological and prognostic data of 1346 cases of postoperative renal cell carcinoma during July 2002 to June 2014 in West China Hospital were collected retrospectively.There were 839 males and 507 females,aged(55.1±13.4)years,including 1120 cases of clear cell RCC,62 cases of papillary RCC,79 cases of chromophobe RCC and 85 cases of the other pathological types respectively.ECOG 0 and≥1 were 911 and 435 cases,with;T1,T2,T3 and T4 of 1019,177,102 and 48 cases respectively;WHO nuclear grade for well,intermediate,poor differentiation and unknown were 587,530,85 and 144 cases separately.Tumor size<5cm,5-10cm,≥10cm and unknown were 685,541,104 and 16 cases.Combined with necrosis or sacromatoid differentiation were 200/1146 and 27/1319 cases separately.Meanwhile,data of 80439 cases from Surveillance,Epidemiology,and End Results Program(SEER)were also collected.There were 51371 males and 29068 females,aged(60.9±12.4)years;,with 66261,8680,5022 and 476 cases of White,Black,Asian,American native,or unknown race separately.There were 62600 of clear cell RCC,12170 of papillary RCC,4354 of chromophobe RCC and 1315 of other pathological types,with T1,T2,T3 and T4 of 55332,8687,15516 and 904 cases respectively;WHO nuclear grade for well,intermediate and poor differentiation were 52323,22700 and 5416 cases separately.Tumor size<5cm,5-10cm,≥10cm were 46741,25760 and 7938 cases respectively.Kaplan-Meier survival analysis were performed on these two group of cases,with different factors between subgroups(gender,age,pathological types,tumor stage,size and nuclear grade)evaluated by log-rank test.To evaluate accuracy of outcome prediction models of SSIGN,Leibovich and UISS score,concordance index of these models were evaluated.Results In 1346 cases of our cohort,those with chromophobe RCC were well prognostic,survival were relatively better in clear cell RCC than that of papillary RCC,and worst prognos

关 键 词：癌 肾细胞 预后 病理类型 人种 预测模型 

分 类 号：R737.11[医药卫生—肿瘤]