肾透明细胞癌部分切术后复发相关因素分析

摘要

目的:探讨肾透明细胞癌患者行部分切术后出现复发转移的相关风险因素.方法:回顾性分析2006年1月~2015年12月间在中国人民解放军总医院泌尿外科接受肾部分切除术的1 742例单侧散发性肾透明细胞癌患者的临床病理资料和随访结果,通过单因素和多因素分析影响其术后复发转移的相关因素.结果:患者的随访时间为3.1~120.7个月,中位随访时间为32.4个月,平均随访时间为36.3个月,其中33例(1.9%)出现复发.单因素分析提示Fuhrman分级(HR=4.476,95% CI=1.717~11.672,P=0.002)、肿瘤坏死(HR=5.728,95% CI=2.478~13.241,P<0.001)和肉瘤样变(HR=29.636,95% CI=3.991~220.062,P=0.001)对肾透明细胞癌部分切术后无复发生存有显著影响,多因素分析也提示Fuhrman分级(HR=3.223,95% CI=1.161~8.946,P=0.025)、肿瘤坏死(HR=5.150,95% CI=2.195~12.081,P<0.001)和肉瘤样变(HR=16.321,95% CI=1.973~134.992,P=0.01)是肾透明细胞癌部分切术后无复发生存的独立影响因素.结论:Fuhrman分级、肿瘤坏死和肉瘤样变是肾透明细胞癌患者行肾部分切除术后复发的相关风险因素.%Objective:To explore the related risk factors of recurrence and metastasis of clear cell renal cell carcinoma (ccRCC) after partial nephrectomy (PN).Methods:We retrospectively analyzed the clinicopathological data and follow-up results of 1 742 sporadic unilateral ccRCC patients who underwent PN in Urology Department of PLA General Hospital from January 2006 to December 2015,and the related factors of post-operative recurrence and metastasis were obtained by univariate and multivariate analysis.Results:The patients were followed up for 3.1-120.7 months with the median follow-up time of 32.4 months (mean 36.3 months).Thirty-three patients had recurrence (1.9%).Univariate analysis showed that Fuhrman grade (HR=4.476,95% CI=1.717-11.672,P=0.002),tumor necrosis (HR=5.728,95% CI=2.478-13.241,P<0.001) and sarcomatoid differenciation (HR=29.636,95% CI=3.991-220.062,P=0.001) had significant effects on the recurrence-free survival of ccRCC patients after PN.Multivariate analysis also revealed that Fuhrman grade (HR=3.223,95% CI=1.161-8.946,P=0.025),tumor necrosis (HR=5.150,95% CI=2.195-12.081,P<0.001) and sarcomatoid differenciation (HR=16.321,95% CI=1.973-134.992,P=0.01) were independent factors of recurrence-free survival of ccRCC patients after PN.Conclusions:Fuhrman grade,tumor necrosis,and sarcomatoid differenciation are related risk factors for recurrence of ccRCC patients after PN.