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目的 :分析影响肾细胞癌患者的预后因素。方法 :研究对象为2008年1月—2013年12月在新疆医科大学附属肿瘤医院泌尿科确诊的334例初治肾细胞癌患者,均有完整的临床病理资料和随访资料。应用Kaplan-Meier法进行预后的单因素分析,采用COX回归模型进行预后的多因素分析。结果 :随访期间,334例患者中有43例因肾细胞癌死亡(12.9%),69例(20.7%)出现疾病复发或进展。334例患者的1年、3年和5年生存率分别为95.2%、86.3%和83.6%。血清钙水平、病理类型、TNM分期、肿瘤有无坏死以及有无静脉癌栓是肾细胞癌患者的独立预后因素(P值均<0.05)。亚组分析结果显示,肾细胞癌根治术组与保留肾单位手术组患者的5年生存率差异无统计学意义(P>0.05),开放手术与腹腔镜手术的5年生存率差异亦无统计学意义(P>0.05)。结论 :血清钙水平、病理类型、TNM分期、肿瘤有无坏死以及有无静脉癌栓是肾细胞癌患者的独立预后因素。对存在不良预后因素的患者应给予积极的综合治疗以提高生存率。
Objective: To analyze the prognostic factors affecting patients with renal cell carcinoma. Methods: The data of 334 patients with newly diagnosed renal cell carcinoma diagnosed in Department of Urology, Cancer Hospital Affiliated to Xinjiang Medical University from January 2008 to December 2013, all had complete clinical pathological data and follow-up data. Univariate analysis of prognosis using Kaplan-Meier method, multivariate analysis of prognosis using COX regression model. Results: During the follow-up period, 43 of 334 patients died of renal cell carcinoma (12.9%) and 69 patients (20.7%) developed disease recurrence or progression. One-year, three-year, and five-year survival rates for the 334 patients were 95.2%, 86.3%, and 83.6%, respectively. Serum calcium levels, pathological types, TNM stage, tumor necrosis, and presence or absence of venous thrombosis were independent prognostic factors for patients with renal cell carcinoma (P <0.05). Subgroup analysis showed that the 5-year survival rate of patients with renal cell carcinoma radical nephrectomy group and retained nephron surgery group was no significant difference (P> 0.05), 5-year survival rate of open surgery and laparoscopic surgery was no statistical difference Significance (P> 0.05). Conclusion: Serum calcium level, pathological type, TNM staging, tumor necrosis and vein thrombosis are independent prognostic factors of patients with renal cell carcinoma. Patients with adverse prognostic factors should be given positive comprehensive treatment to improve the survival rate.