无远处转移肾癌伴肾静脉瘤栓的长期疗效和预测影响因素

发布时间：2018-01-12 22:14

本文关键词：无远处转移肾癌伴肾静脉瘤栓的长期疗效和预测影响因素　出处：《中国微创外科杂志》2016年03期 　论文类型：期刊论文

【摘要】：目的探讨无远处转移肾癌伴肾静脉瘤栓患者行开腹根治性肾切除联合瘤栓取出术的预后影响因素。方法回顾性分析2000年1月~2014年9月我院113例术后病理证实为肾癌伴肾静脉瘤栓的临床资料,均为Mayo 0级瘤栓,采用Kaplan-Meier生存分析,Cox比例风险模型评价肾癌伴肾静脉瘤栓的预后。结果 106例获得随访,随访率93.8%(106/113),中位随访时间61个月(12~186个月),36例死亡,中位生存127个月(5~186个月),5年肿瘤特异性生存率(cancer-specific survival,CSS)为61.3%,10年CSS为50.4%。Cox比例风险模型结果显示副瘤综合征(β=2.457,P=0.000)、Fuhrman分级(G3/4)(β=2.617,P=0.000)和肾周脂肪受累(β=1.369,P=0.002)是肾癌伴肾静脉瘤栓患者的独立预后因素,同时伴有3项危险因素的患者中位生存仅14个月。结论术前无远处转移的肾癌伴肾静脉瘤栓患者行开腹根治性肾切除联合瘤栓取出术后预后良好,伴有副瘤综合征,高Fuhrman分级和肾周脂肪受累的患者预后差。
[Abstract]:Objective to investigate the prognostic factors of patients with renal carcinoma without distant metastasis associated with renal vein tumor embolus by open radical nephrectomy combined with removal of tumor embolus. Methods from January 2000 to September 2014, we retrospectively analyzed the prognostic factors in our hospital. The clinical data of renal carcinoma with renal vein thrombus were confirmed by pathology. All of them were Mayo grade 0 tumor thrombus. The prognosis of renal cell carcinoma with renal vein thrombus was evaluated by Kaplan-Meier survival analysis and Cox proportional risk model. Results 106 cases were followed up. The follow-up rate was 93. 8% of 106 / 113, and the median follow-up time was 61 months, 12 ~ 186 months, 36 cases died, and the median survival was 127 months or 5 ~ 186 months). The 5-year tumor-specific survival rate was 61.3%. The 10-year CSS was 50.4. Cox proportional risk model showed paraneoplastic syndrome (尾 -2.457). Fuhrman graded G _ 3 / 4 (尾 _ (2.617) P _ (0.000)) and perirenal fat involvement (尾 ~ (1.369)). P0. 002) is an independent prognostic factor in patients with renal cell carcinoma with renal vein thrombus. The median survival of the patients with 3 risk factors was only 14 months. Conclusion the patients with renal carcinoma without distant metastasis and renal vein thrombus have a good prognosis after radical nephrectomy and thrombus removal. The prognosis of patients with paraneoplastic syndrome, high Fuhrman grade and perirenal fat involvement was poor.
【作者单位】：北京协和医学院中国医学科学院肿瘤医院泌尿外科;
【分类号】：R737.11
【正文快照】： 肾细胞癌是泌尿系统常见的恶性肿瘤,静脉系统受侵是肾细胞癌独特的生物学特性之一,发生率5%~15%[1],以肾静脉瘤栓最为常见,占静脉瘤栓的60%~78%[2,3]。本文回顾性分析2000年1月~2014年9月我院113例根治性肾切除联合肾静脉瘤栓取出术的临床资料,占同期肾癌患者2.84%(113/3976),

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