肾盂鳞状细胞癌20年回顾性分析

发布时间：2018-01-27 01:12

本文关键词： 肾盂癌鳞状细胞癌回顾性 Cox回归模型　出处：《中南大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：总结肾盂鳞状细胞癌临床、病理特征,从人体测量学指标、临床病史资料等方面分析影响肾盂鳞状细胞癌预后的危险因素,比较各因素对肾鳞状细胞患者肿瘤复发转移及生存时间的影响,为改善肾盂鳞状细胞癌患者预后找到行之有效的方法。方法：采用回顾性分析方法,收集近20年在中南大学湘雅医院和中南大学湘雅二医院就诊,且符合纳入标准及排除标准的病例资料,采用电话或短信追踪随访并结合院内已归档病例相关资料进行研究,数据基本资料的描述采用频数和百分比表示。探讨影响肾盂鳞状细胞癌生存的危险因素采用COX回归模型进行计算。计算不同手术方式、是否化疗、肿瘤T分期、肿瘤N分期组等的中位生存时间和生存率差异显著性比较应用Kaplan-Meier法和Long-rank秩检验。结果：(1)37例肾盂鳞状细胞癌患者中,平均诊断年龄为61.0±8.3岁、身高体重指数(BMI)平均值为19.9±2.2kg/m2,以文化程度低、低收入、基础卫生医疗设施薄弱地区的人群居多,且男性多于女性；(2)所有研究对象中,存在肾脏积水和(或)积脓或感染征象者为31例,占入选病例83.8%；存在同侧肾结石病史患者29例,占入选病例78.3%,其中存在10年以下结石病史患者14例(占37.8%),存在10年以上结石病史患者15例(占40.5%)；无结石病史患者8例(占21.6%)；所有患者中同时存在以上多种危险因素者为25例；(3)根据Cox回归模型进行单因素分析,影响预后的影响因素有肿瘤T分期(P=0.004)、肿瘤N分期(P=0.01)、肿瘤分化程度(P=0.01)及确诊时间(P=0.004)；逐步筛选模型多因素分析结果为肿瘤T分期是影响预后的独立预测因子(P=0.004)。(4)肾鳞癌的肿瘤T分期、肿瘤N分期、肿瘤分化程度是评估术后生存期的可靠指标,相同的肿瘤T分期\N分期以及肿瘤分化程度的患者,无论行什么手术方式和术后放化疗处理,生存期都无明显统计学差异。结论：(1)肾盂鳞状细胞癌中,低文化、低收入、基础卫生医疗设施薄弱地区,≥50岁人群,男性构成比较高。(2)肾结石、肾脏积水和(或)积脓和(或)感染可伴发肾盂鳞状细胞癌,(3)影响预后的影响因素有肿瘤T分期、肿瘤N分期、肿瘤分化程度。(4)肾鳞癌的肿瘤T分期、肿瘤N分期以及肿瘤分化程度是评估术后生存期的可靠指标,相同的肿瘤T分期\N分期以及肿瘤分化的患者,无论行何种手术方式和是否进行术后放化疗,生存期都无明显统计学差异。
[Abstract]:Objective: to summarize the clinical and pathological features of squamous cell carcinoma of renal pelvis and analyze the risk factors influencing the prognosis of squamous cell carcinoma of renal pelvis from the aspects of anthropometric indexes and clinical history. To compare the effects of various factors on tumor recurrence, metastasis and survival time in renal squamous cell carcinoma (RSCC), an effective method was found to improve the prognosis of renal squamous cell carcinoma (RSCC). Methods: retrospective analysis was used to collect the data of patients who had been treated in Xiangya Hospital of Central South University and Xiangya II Hospital of Central South University in the past 20 years, and met the criteria of inclusion and exclusion. The patients were followed up by telephone or short message and studied with the data of the cases filed in the hospital. The basic data were described by frequency and percentage. The risk factors affecting the survival of squamous cell carcinoma of renal pelvis were calculated by COX regression model. The median survival time and survival rate of T staging group and N stage group were significantly different by Kaplan-Meier and Long-rank rank test. Results in 37 patients with squamous cell carcinoma of renal pelvis, the average age of diagnosis was 61.0 卤8.3 years, and the mean value of BMIs was 19.9 卤2.2 kg / m2. In the areas with low education, low income, weak basic health care facilities, the majority of the population, and more men than women; (2) among all the subjects, there were 31 cases with hydronephrosis and / or pyosis or infection, accounting for 83.8% of the selected cases. There were 29 cases with history of ipsilateral renal calculi, accounting for 78.3% of the selected cases, of which 14 cases (37.8%) had a history of less than 10 years of lithiasis. 15 patients (40.5%) had a history of lithiasis for more than 10 years. 8 cases (21.6%) had no history of lithiasis; Among all the patients, 25 cases had multiple risk factors. (3) univariate analysis based on Cox regression model showed that the influencing factors of prognosis were tumor T stage P0. 004, tumor N stage P0. 01). The degree of differentiation of the tumor was 0.01) and the time of diagnosis was 0.004%. Multivariate analysis of stepwise screening model showed that tumor T stage was an independent prognostic factor for prognosis of renal squamous cell carcinoma (RSCC). The degree of tumor differentiation is a reliable index to evaluate postoperative survival. Patients with the same tumor T / N stages and tumor differentiation degree, no matter what operation mode and postoperative radiotherapy and chemotherapy treatment. There was no significant difference in survival time. Conclusion: in squamous cell carcinoma of renal pelvis, low education, low income, weak basic health and medical facilities, and more than 50 years old, the composition of male is relatively high. The prognostic factors of hydronephrosis and / or pyosis and / or infection associated with squamous cell carcinoma of renal pelvis were T stage and N stage of tumor. The tumor T stage, tumor N stage and tumor differentiation degree of renal squamous cell carcinoma (RSCC) were reliable indexes to evaluate postoperative survival, same tumor T staging / N stage and tumor differentiation. There was no significant difference in survival between the two groups.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.11

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