肾细胞癌的临床病理特征及其特异性生存影响因素分析

发布时间：2018-08-25 12:50

【摘要】：肾细胞癌(Renal Cell Carcinoma,RCC)是泌尿系统常见的恶性肿瘤,约占成人恶性肿瘤的2%-3%。在我国肾癌的发病率居第三位仅次于膀胱癌及前列腺癌,且其发病率呈逐年上升趋势。肾癌预后影响因素包括解剖学因素、组织学因素、临床因素和分子因素等。解剖学因素主要是肿瘤的TNM分期情况。组织学因素包括Fuhrman分级、肿瘤内改变等。既往认为肾癌的预后与组织学类型有关,然而国外一项肾癌患者预后的多中心研究结果显示,组织学亚型并不是独立的预后因素。临床因素包括患者行为状态评分(Karnofsky评分,KPS评分)、症状及血清学指标等。分子因素主要是肾癌的免疫组化指标,然而,这些分子指标并不能有效提高目前预后系统的准确性,因此,实践中并未推荐常规使用这些分子指标。目前对于肾癌预后因素的研究仍存在较大差异,各评价系统的准确性仍有待提高。研究肾癌预后因素对于指导治疗方案的选择有着重大意义。目的:究通过整理我院2006年12月至2011年12月手术治疗的369例原发性肾癌患者的临床及病理资料,并进行随访,获得患者的肿瘤特异性生存期,通过单因素及多因素分析得出国人肾癌预后的评价系统。一、肾细胞癌的临床病理特征方法:主要分析了我院2006年12月至2011年12月手术治疗的原发性肾癌患者的临床病理资料及随访资料。结果:本研究发现纳入的369例患者平均年龄为53.4±12.4岁,男女比例为2.6:1,患者平均体质指数(Body Mass Index,BMI)为24.2±3.4。出现症状的患者有108名,占29.3%,其中腰腹部不适者62个,占16.8%;血尿者36个,占9.8%;腹部肿块者4个,占1.1%。无症状的患者有261名,占70.7%。术前发现贫血的患者有21个,占5.7%;谷草转氨酶(Aspartate Aminotransferase,AST)升高的患者11个,占3.0%。肿瘤平均最大径为4.6±2.6cm。肿瘤内出血者44例,占11.9%;肿瘤内坏死者37例,占10.0%;肿瘤囊性变者43例,占11.7%;肿瘤肉瘤样变者4例,占1.0%。伴有静脉癌栓者9例,占2.4%。肿瘤组织亚型为透明细胞癌者322例,占87.2%;乳头状腺癌者22例,占6.0%;嫌色细胞癌15例,占4.1%;多房囊性肾癌9例,占2.4%;未分类癌1例,占0.3%。免疫组化染色Ki-67低表达358例,占97.0%,高表达者11例,占3.0%;Fuhrman分级为G1+G2者200例,占54.2%,G3+G4者169例,占45.8%;肿瘤T分期为T1+T2者342例,占92.7%,T3+T4者27例,占7.3%。年龄44岁、出现症状、贫血、有静脉癌栓及出现肿瘤内坏死的患者肿瘤T分期较高(P0.05);出现肿瘤内坏死、肉瘤样变及Ki-67高表达的患者肿瘤Fuhrman分级较高(P0.05);而其它研究因素与肿瘤分期、分级间无统计学差异。5年内发生远端转移的患者有27例,占同期肾癌患者的13.5%。最常见的转移部位是肺部,有13例,占48.1%,其次为骨转移和脑转移,各4例,占14.8%,肝转移3例,占11.1%。结论:本研究发现,我院肾癌患者的临床病理特征基本与国外研究一致。二、肾细胞癌肿瘤特异性生存影响因素分析方法:主要分析了我院2006年12月至2011年12月手术治疗的原发性肾癌患者的临床及病理资料进行单因素及多因素分析,Kaplan-Meier方法绘制肿瘤特异性生存曲线。结果:本研究发现在本部分中,通过随访获得了我院肾癌患者术后生存情况,研究肿瘤特异性生存生存的影响因素。单因素分析中,性别、AST升高、病理类型、肿瘤内出血、肿瘤囊性变不影响患者肿瘤特异性生存。年龄、BMI、临床症状、贫血、静脉癌栓、肿瘤内坏死、肉瘤样变、Ki-67表达、肿瘤Furhman分级及T分期是影响肿瘤特异性生存的相关因素。多因素Cox回归中发现,静脉癌栓、肿瘤内坏死、肉瘤样变、Ki-67表达、Fuhrman分级、T分期是影响患者肿瘤特异性生存的独立影响因素。结论:本研究发现,静脉癌栓、肿瘤内坏死、肉瘤样变、Ki-67表达、Fuhrman分级、T分期是影响患者肿瘤特异性生存的独立影响因素。
[Abstract]:Renal Cell Carcinoma (RCC) is a common malignant tumor of the urinary system, accounting for 2% - 3% of adult malignancies. The incidence of renal cell carcinoma in China ranks third only after bladder cancer and prostate cancer, and its incidence is increasing year by year. Histological factors include Fuhrman grading, intratumoral changes and so on. Histological factors have previously been associated with histological types of renal cell carcinoma. However, a multicenter study of the prognosis of patients with renal cell carcinoma abroad has shown that histological subtypes are not independent prognostic factors. Molecular factors are mainly immunohistochemical markers of renal cell carcinoma. However, these markers can not effectively improve the accuracy of the current prognostic system. Therefore, routine use of these molecular markers is not recommended in practice. The prognostic factors of renal cell carcinoma (RCC) are of great significance in guiding the selection of therapeutic regimens. Objective: To study the clinical and pathological data of 369 patients with primary renal cell carcinoma (PRC) who underwent surgical treatment in our hospital from December 2006 to December 2011, and to follow up the patients. Tumor-specific survival was assessed by univariate and multivariate analysis. 1. Clinicopathological characteristics of renal cell carcinoma. Methods: The clinicopathological data and follow-up data of patients with primary renal cell carcinoma who underwent surgical treatment in our hospital from December 2006 to December 2011 were analyzed. The average age of 9 patients was 53.4+12.4 years, the ratio of male to female was 2.6:1, and the average body mass index (BMI) was 24.2+3.4. 108 patients (29.3%) had symptoms, including 62 patients with lumbar and abdominal discomfort (16.8%), 36 patients with hematuria (9.8%) and 4 patients with abdominal mass (1.1%). There were 21 anemia patients, accounting for 5.7%; 11 aspartate aminotransferase (AST) elevated patients, accounting for 3.0%. The average maximum diameter of the tumor was 4.6 (+ 2.6 cm). 44 cases (11.9%) had intratumoral hemorrhage, 37 cases (10.0%) had intratumoral necrosis, 43 cases (11.7%) had cystic degeneration, 4 cases (1.0%) had tumor sarcomatoid degeneration, and 9 cases (9.0%) had intravenous tumor thrombus. There were 322 cases (87.2%) of clear cell carcinoma, 22 cases (6.0%) of papillary adenocarcinoma, 15 cases (4.1%) of chromophobe cell carcinoma, 9 cases (2.4%) of multilocular cystic renal carcinoma, and 1 case (0.3%) of unclassified carcinoma. There were 169 cases (45.8%) with 3+G4, 342 cases (92.7%) with T1+T2 and 27 cases (7.3%) with T3+T4. The patients with symptoms, anemia, venous tumor thrombus and intratumoral necrosis had higher T stage (P 0.05), and patients with intratumoral necrosis, sarcomatoid degeneration and high expression of Ki-67 had higher Fuhrman grade (P 0.05). The most common metastatic sites were lung, 13 cases (48.1%), followed by bone metastasis and brain metastasis, 4 cases (14.8%) and 3 cases (11.1%) of liver metastasis. Pathological characteristics are basically consistent with foreign studies. 2. Analysis of factors affecting tumor-specific survival of renal cell carcinoma: We analyzed the clinical and pathological data of primary renal cell carcinoma patients who underwent surgery from December 2006 to December 2011 in our hospital for univariate and multivariate analysis. Kaplan-Meier method was used to draw tumor-specific survival curve. Results: In this part, we found that the survival of renal cell carcinoma patients in our hospital was obtained through follow-up, and the factors influencing tumor-specific survival were studied. Thrombosis, intratumoral necrosis, sarcomatoid degeneration, Ki-67 expression, Furhman grade and T stage of the tumor were related factors affecting tumor-specific survival. Multivariate Cox regression showed that venous tumor thrombus, intratumoral necrosis, sarcomatoid degeneration, Ki-67 expression, Fuhrman grade and T stage were independent factors affecting tumor-specific survival. It was found that venous tumor thrombus, necrosis, sarcomatoid degeneration, Ki-67 expression, Fuhrman grade and T stage were independent factors affecting tumor-specific survival.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.11

【参考文献】