减瘤手术对肾癌骨转移患者预后影响:基于SEER数据库分析  

Prognostic impact of cytoreductive nephrectomy on patients with bone metastases from renal cancer:an analysis based on the SEER database

作　　者：李云天 董洋[2] 陈雨昂 韩从辉[2] 张文达[2] LI Yuntian;DONG Yang;CHENG Yuang;HAN Conghui;ZHANG Wenda(Bengbu Medical University,Bengbu,Anhui,233000,China;Department of Urology,Xuzhou Central Hospital;Xuzhou Clinical College of Xuzhou Medical University)

机构地区：[1]蚌埠医科大学,安徽蚌埠233000 [2]徐州市中心医院泌尿外科 [3]徐州医科大学徐州临床学院

出　　处：《临床泌尿外科杂志》2024年第5期374-381,共8页Journal of Clinical Urology

摘　　要：目的探究减瘤手术对肾癌骨转移患者生存预后的影响,为临床决策提供参考。方法本研究基于监测、流行病学和最终结果(surveillance,epidemiology,and end results,SEER)数据库分析,从数据库中收集大量多中心的肾癌患者的临床数据,分别通过logistic法分析了肾癌患者的骨转移的危险因素、Kaplan-Meier法绘制骨转移与非骨转移患者的生存曲线,Cox分析骨转移患者的预后影响因素,并使用倾向性评分匹配法去除混杂因素后分析了减瘤手术对肾癌骨转移患者的预后影响。结果本研究共纳入41221例肾癌患者,其中1038例发生了骨转移,通过对比,骨转移患者呈现以下临床特征:男性、年龄偏高、T分期较晚、多数合并淋巴结及其他器官转移。logistic分析结果显示肾癌骨转移的独立风险因素有:T分期高、合并淋巴结及其他远处器官转移。生存分析显示骨转移患者生存期远低于未转移患者。Cox回归分析显示高龄、T4、N1、远处转移是影响生存的独立危险因素,减瘤手术为独立保护因素。倾向性评分匹配后减瘤手术仍然是影响肾癌骨转移患者预后的独立保护因素。结论肾癌患者发生骨转移的风险因素包括T4肿瘤分期和肺转移。T4肿瘤分期和淋巴结转移通常预示预后不良。减瘤手术对患者生存预后的影响稳定,肾癌骨转移的患者可以通过减瘤手术获得生存获益。Objective To investigate the effect of cytoreductive nephrectomy on the survival prognosis of patients with bone metastases from renal cancer,and to provide reference for clinical decision-making.Methods In this study,a large number of clinical data of renal cancer patients from multiple centers were collected based on the SEER database.The risk factors in bone metastases for patients with RCC were analyzed by the logistic method,and the survival curves of patients with bone metastases versus those with non-bone metastases were plotted by the Kaplan-Meier method.Prognostic influences on patients with bone metastases were analyzed by the Cox.The prognostic impact of cytoreductive nephrectomy on RCC-BM patients was analyzed after removing confounding factors.Results A total of 41221 renal cancer patients were included in this study,of which 1038 had bone metastases.By comparison,patients with bone metastases presented the following clinical characteristics:male,old age,late T stage,and most of them combined with lymph node and other organ metastases.Logistic analysis showed that the independent risk factors in bone metastases of renal cancer were:high T stage,combined with lymph node and other distant organ metastases.Survival analysis showed that the survival of bone metastases was much lower than that of patients without metastases.Cox regression analysis showed that advanced age,T4,N1,and distant metastases were independent risk factors affecting survival,and cytoreductive nephrectomy was an independent protective factor.Cytoreductive nephrectomy remained an independent protective factor affecting the prognosis of patients with RCC-BM after PSM.Conclusion Risk factors in bone metastases for patients with kidney cancer include T4 tumor stage and lung metastases.T4 tumor stage and lymph node metastases usually portend a poor prognosis.Tumor reduction surgery has a stable impact on survival prognosis,and patients with bone metastases from renal cancer can receive a survival benefit from cytoreductive nephrectomy.

关 键 词：SEER数据库 肾癌 骨转移 预后 减瘤手术 R语言 

分 类 号：R737.11[医药卫生—肿瘤]