非转移性肾细胞癌的术前危险分层

目的 探讨建立一种非转移性肾细胞癌(RCC)术前危险因素的评价模型. 方法 回顾性分析了3个中心实施手术治疗的363例非转移性RCC患者资料,Cox比例风险模型进行单因素和多因素分析,评价影响患者生存期的临床以及病理变量,并建立再现风险公式(RRF). 结果 363例平均随访46个月,2年及5年总体生存率为90%(326/363)及54%(196/363),术后复发71例.Cox单因素分析中4个变量对预后有影响,即临床表现(RR=50.583,P=0.000)、肿瘤大小(RR=104.018,P-0.000)、肿瘤分期(RR-135.145,P=0.000)、分级(RR=86.397,P=0.000).Cox多因素分析中,临床表现(RR=6.946,P=0.008)、肿瘤大小(RR=9.353,P=0.002)、分期(RR=69.580,P=0.000)、分级(RR=15.363,P=0.000)仍然对预后具有明显影响.通过Cox多因素分析结果建立了RRF(0.530×临床表现+0.749×肿瘤大小).等式分组后,RRF≤1.3组的2年及5年生存率为100.0%(147例)及71.3%(105例),RRF＞1.3组的2年及5年生存率为82.8%(179例)、38.1%(82例),2组预后差异有统计学意义(P＜0.01). 结论 建立了一个独立于分期、分级,仅使用术前变量对非转移性RCC危险分层的公式.RRF有助于术前判断患者预后以及实施个体化随访和辅助治疗方案.

Preoperative risk stratification for non-metastatic renal cell carcinoma

Objective To develop a mathematical model to stratificate the risk of the non-metastatic renal cell carcihoma(RCC)before operation. Methods The clinical and follow-up data of 363 patients with RCC treated by operation in three hospitals were retrospectively analyzed by Cox univariate and multivariate analysis.And the recurrence risk formula was constructed. Results The mean follow-up time was 46 months,the 2-year and 5-year overall survival rates were 90%and 54%,respectively.Seventy-one patients had recurrence after operation.In univariate analysis,clinical presentation(RR-50.583,P=0.000),tumor size(RR=104.018,P=0.000),stage(RR=135.145,P=0.000),grade(RR=86.397,P=0.000)could influence the prognosis of patients.In multivariate analysis these four varieties still showed significant influence on prognosis with clinical presentation(RR=6.946,P=0.008),size(RR=9.353,P=0.002),stage(RR=69.580,P=0.000),grade(RR=15.363,P=0.000).Based on the outcome of Cox regression,the formula of RRF=(0.530×clinical manifanestion+0.749×size)was constructed.By using this formula,the overall 2-year and 5-year survival rates of RRF≤1.3 were 100.0%and 71.3%respectively,the overall 2-year and 5-year rates＞1.3 were 82.8%and 38.1%respectively.There was significant difference between two groups (P＜0.01). Conclusions A model was constructed independent of stage and grade to stratifieate the non-metastatic RCC.RRF can be used to judge the prognosis of non-metastatic RCG before operation,and help to perform individual follow-up and adjuvant therapy.