腎細(xì)胞癌的臨床病理特征及其特異性生存影響因素分析
發(fā)布時(shí)間：2018-08-25 12:50
【摘要】：腎細(xì)胞癌(Renal Cell Carcinoma,RCC)是泌尿系統(tǒng)常見的惡性腫瘤,約占成人惡性腫瘤的2%-3%。在我國(guó)腎癌的發(fā)病率居第三位僅次于膀胱癌及前列腺癌,且其發(fā)病率呈逐年上升趨勢(shì)。腎癌預(yù)后影響因素包括解剖學(xué)因素、組織學(xué)因素、臨床因素和分子因素等。解剖學(xué)因素主要是腫瘤的TNM分期情況。組織學(xué)因素包括Fuhrman分級(jí)、腫瘤內(nèi)改變等。既往認(rèn)為腎癌的預(yù)后與組織學(xué)類型有關(guān),然而國(guó)外一項(xiàng)腎癌患者預(yù)后的多中心研究結(jié)果顯示,組織學(xué)亞型并不是獨(dú)立的預(yù)后因素。臨床因素包括患者行為狀態(tài)評(píng)分(Karnofsky評(píng)分,KPS評(píng)分)、癥狀及血清學(xué)指標(biāo)等。分子因素主要是腎癌的免疫組化指標(biāo),然而,這些分子指標(biāo)并不能有效提高目前預(yù)后系統(tǒng)的準(zhǔn)確性,因此,實(shí)踐中并未推薦常規(guī)使用這些分子指標(biāo)。目前對(duì)于腎癌預(yù)后因素的研究仍存在較大差異,各評(píng)價(jià)系統(tǒng)的準(zhǔn)確性仍有待提高。研究腎癌預(yù)后因素對(duì)于指導(dǎo)治療方案的選擇有著重大意義。目的:究通過整理我院2006年12月至2011年12月手術(shù)治療的369例原發(fā)性腎癌患者的臨床及病理資料,并進(jìn)行隨訪,獲得患者的腫瘤特異性生存期,通過單因素及多因素分析得出國(guó)人腎癌預(yù)后的評(píng)價(jià)系統(tǒng)。一、腎細(xì)胞癌的臨床病理特征方法:主要分析了我院2006年12月至2011年12月手術(shù)治療的原發(fā)性腎癌患者的臨床病理資料及隨訪資料。結(jié)果:本研究發(fā)現(xiàn)納入的369例患者平均年齡為53.4±12.4歲,男女比例為2.6:1,患者平均體質(zhì)指數(shù)(Body Mass Index,BMI)為24.2±3.4。出現(xiàn)癥狀的患者有108名,占29.3%,其中腰腹部不適者62個(gè),占16.8%;血尿者36個(gè),占9.8%;腹部腫塊者4個(gè),占1.1%。無癥狀的患者有261名,占70.7%。術(shù)前發(fā)現(xiàn)貧血的患者有21個(gè),占5.7%;谷草轉(zhuǎn)氨酶(Aspartate Aminotransferase,AST)升高的患者11個(gè),占3.0%。腫瘤平均最大徑為4.6±2.6cm。腫瘤內(nèi)出血者44例,占11.9%;腫瘤內(nèi)壞死者37例,占10.0%;腫瘤囊性變者43例,占11.7%;腫瘤肉瘤樣變者4例,占1.0%。伴有靜脈癌栓者9例,占2.4%。腫瘤組織亞型為透明細(xì)胞癌者322例,占87.2%;乳頭狀腺癌者22例,占6.0%;嫌色細(xì)胞癌15例,占4.1%;多房囊性腎癌9例,占2.4%;未分類癌1例,占0.3%。免疫組化染色Ki-67低表達(dá)358例,占97.0%,高表達(dá)者11例,占3.0%;Fuhrman分級(jí)為G1+G2者200例,占54.2%,G3+G4者169例,占45.8%;腫瘤T分期為T1+T2者342例,占92.7%,T3+T4者27例,占7.3%。年齡44歲、出現(xiàn)癥狀、貧血、有靜脈癌栓及出現(xiàn)腫瘤內(nèi)壞死的患者腫瘤T分期較高(P0.05);出現(xiàn)腫瘤內(nèi)壞死、肉瘤樣變及Ki-67高表達(dá)的患者腫瘤Fuhrman分級(jí)較高(P0.05);而其它研究因素與腫瘤分期、分級(jí)間無統(tǒng)計(jì)學(xué)差異。5年內(nèi)發(fā)生遠(yuǎn)端轉(zhuǎn)移的患者有27例,占同期腎癌患者的13.5%。最常見的轉(zhuǎn)移部位是肺部,有13例,占48.1%,其次為骨轉(zhuǎn)移和腦轉(zhuǎn)移,各4例,占14.8%,肝轉(zhuǎn)移3例,占11.1%。結(jié)論:本研究發(fā)現(xiàn),我院腎癌患者的臨床病理特征基本與國(guó)外研究一致。二、腎細(xì)胞癌腫瘤特異性生存影響因素分析方法:主要分析了我院2006年12月至2011年12月手術(shù)治療的原發(fā)性腎癌患者的臨床及病理資料進(jìn)行單因素及多因素分析,Kaplan-Meier方法繪制腫瘤特異性生存曲線。結(jié)果:本研究發(fā)現(xiàn)在本部分中,通過隨訪獲得了我院腎癌患者術(shù)后生存情況,研究腫瘤特異性生存生存的影響因素。單因素分析中,性別、AST升高、病理類型、腫瘤內(nèi)出血、腫瘤囊性變不影響患者腫瘤特異性生存。年齡、BMI、臨床癥狀、貧血、靜脈癌栓、腫瘤內(nèi)壞死、肉瘤樣變、Ki-67表達(dá)、腫瘤Furhman分級(jí)及T分期是影響腫瘤特異性生存的相關(guān)因素。多因素Cox回歸中發(fā)現(xiàn),靜脈癌栓、腫瘤內(nèi)壞死、肉瘤樣變、Ki-67表達(dá)、Fuhrman分級(jí)、T分期是影響患者腫瘤特異性生存的獨(dú)立影響因素。結(jié)論:本研究發(fā)現(xiàn),靜脈癌栓、腫瘤內(nèi)壞死、肉瘤樣變、Ki-67表達(dá)、Fuhrman分級(jí)、T分期是影響患者腫瘤特異性生存的獨(dú)立影響因素。
[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.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R737.11
本文編號(hào)：2202937
[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.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R737.11
【參考文獻(xiàn)】
相關(guān)期刊論文 前1條
1 李鳴;何志嵩;高江平;孫穎浩;李長(zhǎng)嶺;黃翼然;孫光;王國(guó)民;;多中心腎癌臨床特征分析[J];中華泌尿外科雜志;2010年02期
，本文編號(hào)：2202937
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