单中心1 367例根治性肾切除肾癌患者的远期生存分析
目的:总结报道中山大学肿瘤防治中心肾癌患者根治性肾切除术后的远期生存情况。方法:收集1999—2020年在中山大学肿瘤防治中心接受根治性肾切除术的1 367例无远处转移肾癌患者的临床病理和随访资料，以总生存为主要研究终点，采用Kaplan－Meier法进行生存分析，组间生存率的比较采用Log rank检验。肾癌患者根治性肾切除术后总生存的影响因素分析采用单因素和多因素Cox比例风险模型回归分析。结果:中位随访52.6个月，1 367例患者中死亡267例，存活1 100例，中位总生存时间尚未达到，5年和10年总生存率分别为82.8%和74.9%。Leibovich评分低危组、中危组和高危组患者的...
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| Published in | 中华肿瘤杂志 Vol. 45; no. 11; pp. 981 - 987 |
|---|---|
| Main Authors | , , , , , , , , , , , , |
| Format | Journal Article |
| Language | Chinese |
| Published |
中山大学肿瘤防治中心 华南恶性肿瘤防治全国重点实验室 肿瘤医学协同创新中心泌尿外科，广州 510060%中山大学肿瘤防治中心 华南恶性肿瘤防治全国重点实验室 肿瘤医学协同创新中心影像科，广州 510060
01.11.2023
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0253-3766 |
| DOI | 10.3760/cma.j.cn112152-20220614-00420 |
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| Abstract | 目的:总结报道中山大学肿瘤防治中心肾癌患者根治性肾切除术后的远期生存情况。方法:收集1999—2020年在中山大学肿瘤防治中心接受根治性肾切除术的1 367例无远处转移肾癌患者的临床病理和随访资料，以总生存为主要研究终点，采用Kaplan－Meier法进行生存分析，组间生存率的比较采用Log rank检验。肾癌患者根治性肾切除术后总生存的影响因素分析采用单因素和多因素Cox比例风险模型回归分析。结果:中位随访52.6个月，1 367例患者中死亡267例，存活1 100例，中位总生存时间尚未达到，5年和10年总生存率分别为82.8%和74.9%。Leibovich评分低危组、中危组和高危组患者的5年总生存率分别为93.3%、82.2%和50.5%，10年总生存率分别为88.2%、72.3%和30.2%，3组远期生存差异有统计学意义(
P<0.001)。pT1期、pT2期、pT3期和pT4期肾癌患者的10年总生存率分别为83.2%、73.6%、55.0%和31.4%，差异有统计学意义(
P<0.001)。有淋巴结转移患者的5年和10年总生存率分别为48.5%和35.6%，无淋巴结转移患者的5年和10年总生存率分别为85.1%和77.5%，差异有统计学意义(
P<0.001)。核分级G1级、G2级、G3级和G4级患者的10年总生存率分别为96.2%、81.6%、60.5%和43.4%，差异有统计学意义(
P<0.001)。局限性肾癌(pT1~2N0M0)患者接受开放手术和微创手术后的10年总生存率分别为80.5%和85.6%，差异无统计学意义(
P＝0.160)。多因素Cox回归分析显示，性别、年龄、体质指数(BMI)、T分期、N分期、病理核分级、肿瘤坏死、肉瘤样分化是肾癌患者根治性肾切除术后总生存的独立影响因素，男性(
HR＝1.55，95%
CI：1.04~2.31)、年龄≥55岁(
HR＝2.11，95%
CI：1.50~2.96)、高T分期(T3~4期比T1a期：
HR＝2.37，95%
CI：1.26~4.46)、N1期(
HR＝3.04，95%
CI：1.81~5.09)、高病理核分级(G3~4比G1：
HR＝4.21，95%
CI：1.51~11.75)、有肿瘤坏死(
HR＝1.66，95%
CI：1.17~2.37)和有肉瘤样分化(
HR＝2.39，95%
CI：1.31~4.36)的肾癌患者根治性肾切 |
|---|---|
| AbstractList | 目的:总结报道中山大学肿瘤防治中心肾癌患者根治性肾切除术后的远期生存情况。方法:收集1999—2020年在中山大学肿瘤防治中心接受根治性肾切除术的1 367例无远处转移肾癌患者的临床病理和随访资料，以总生存为主要研究终点，采用Kaplan－Meier法进行生存分析，组间生存率的比较采用Log rank检验。肾癌患者根治性肾切除术后总生存的影响因素分析采用单因素和多因素Cox比例风险模型回归分析。结果:中位随访52.6个月，1 367例患者中死亡267例，存活1 100例，中位总生存时间尚未达到，5年和10年总生存率分别为82.8%和74.9%。Leibovich评分低危组、中危组和高危组患者的5年总生存率分别为93.3%、82.2%和50.5%，10年总生存率分别为88.2%、72.3%和30.2%，3组远期生存差异有统计学意义(
P<0.001)。pT1期、pT2期、pT3期和pT4期肾癌患者的10年总生存率分别为83.2%、73.6%、55.0%和31.4%，差异有统计学意义(
P<0.001)。有淋巴结转移患者的5年和10年总生存率分别为48.5%和35.6%，无淋巴结转移患者的5年和10年总生存率分别为85.1%和77.5%，差异有统计学意义(
P<0.001)。核分级G1级、G2级、G3级和G4级患者的10年总生存率分别为96.2%、81.6%、60.5%和43.4%，差异有统计学意义(
P<0.001)。局限性肾癌(pT1~2N0M0)患者接受开放手术和微创手术后的10年总生存率分别为80.5%和85.6%，差异无统计学意义(
P＝0.160)。多因素Cox回归分析显示，性别、年龄、体质指数(BMI)、T分期、N分期、病理核分级、肿瘤坏死、肉瘤样分化是肾癌患者根治性肾切除术后总生存的独立影响因素，男性(
HR＝1.55，95%
CI：1.04~2.31)、年龄≥55岁(
HR＝2.11，95%
CI：1.50~2.96)、高T分期(T3~4期比T1a期：
HR＝2.37，95%
CI：1.26~4.46)、N1期(
HR＝3.04，95%
CI：1.81~5.09)、高病理核分级(G3~4比G1：
HR＝4.21，95%
CI：1.51~11.75)、有肿瘤坏死(
HR＝1.66，95%
CI：1.17~2.37)和有肉瘤样分化(
HR＝2.39，95%
CI：1.31~4.36)的肾癌患者根治性肾切 |
| Abstract_FL | Objective:To report the long-term survival of renal cell carcinoma (RCC) patients treated with radical nephrectomy in Sun Yat-sen University Cancer Center.Methods:We retrospectively analyzed the clinical, pathological and follow-up records of 1 367 non-metastatic RCC patients treated with radical nephrectomy from 1999 to 2020 in this center. The primary endpoint of this study was overall survival rate. Survival curves were estimated using the Kaplan-Meier method, and group differences were compared through Log-rank test. Univariate and multivariate Cox analysis were fit to determine the clinical and pathological features associated with overall survival rate.Results:A total of 1 367 patients treated with radical nephrectomy with complete follow-up data were included in the study. The median follow-up time was 52.6 months, and 1 100 patients survived and 267 died, with the median time to overall survival not yet reached. The 5-year and 10-year overall survival rates were 82.8% and 74.9%, respectively. The 5-year and 10-year overall survival rates of Leibovich low-risk patients were 93.3% and 88.2%, respectively; of Leibovich intermediate-risk patients were 82.2% and 72.3%, respectively; and of Leibovich high-risk patients were 50.5% and 30.2%, respectively. There were significant differences in the long-term survival among the three groups (
P<0.001). The 10-year overall survival rates for patients with pT1, pT2, pT3 and pT4 RCC were 83.2%, 73.6%, 55.0% and 31.4%, respectively. There were significant differences among pT1, pT2, pT3 and pT4 patients(
P<0.001). The 5-year and 10-year overall survival rates of patients with lymph node metastasis were 48.5% and 35.6%, respectively, and those of patients without lymph node metastasis were 85.1% and 77.5%, respectively. There was significant difference in the long-term survival between patients with lymph node metastasis and without lymph node metastasis. The 10-year overall survival rate was 96.2% for nuclear Grade 1, 81.6% for nuclear Grade 2, 60.5% for nuclear Grade 3, and 43.4% for nuclear Grade 4 patients. The difference was statistically significant. There was no significant difference in the long-term survival between patients with localized renal cancer (pT1-2N0M0) who underwent open surgery and minimally invasive surgery (10-year overall survival rate 80.5% vs 85.6%,
P=0.160). Multivariate Cox analysis showed that age≥55 years (
HR=2.11, 95%
CI: 1.50-2.96,
P<0.001), T stage(T3+ T4 vs T1a:
HR=2.37, 95%
CI: 1.26-4.46,
P=0.008), local lymph node metastasis (
HR=3.04, 95%
CI: 1.81-5.09,
P<0.001), nuclear grade (G3-G4 vs G1:
HR=4.21, 95%
CI: 1.51-11.75,
P=0.006), tumor necrosis (
HR=1.66, 95%
CI: 1.17-2.37,
P=0.005), sarcomatoid differentiation (
HR=2.39, 95%
CI: 1.31-4.35,
P=0.005) and BMI≥24kg/m
2 (
HR=0.56, 95%
CI: 0.39-0.80,
P=0.001) were independent factors affecting long-term survival after radical nephrectomy.
Conclusions:The long-term survival of radical nephrectomy in patients with renal cell carcinoma is satisfactory. Advanced age, higher pathological stage and grade, tumor necrosis and sarcomatoid differentiation were the main adverse factors affecting the prognosis of patients. Higher body mass index was a protective factor for the prognosis of patients. |
| Author | 周芳坚 张志凌 熊龙滨 董培 邹玲 周朝晖 郭胜杰 韩辉 刘辉明 彭毓璐 邹湘鹏 宁康 俞春萍 |
| AuthorAffiliation | 中山大学肿瘤防治中心 华南恶性肿瘤防治全国重点实验室 肿瘤医学协同创新中心泌尿外科，广州 510060%中山大学肿瘤防治中心 华南恶性肿瘤防治全国重点实验室 肿瘤医学协同创新中心影像科，广州 510060 |
| AuthorAffiliation_xml | – name: 中山大学肿瘤防治中心 华南恶性肿瘤防治全国重点实验室 肿瘤医学协同创新中心泌尿外科，广州 510060%中山大学肿瘤防治中心 华南恶性肿瘤防治全国重点实验室 肿瘤医学协同创新中心影像科，广州 510060 |
| Author_FL | Peng Yulu Zhou Zhaohui Zhou Fangjian Zou Xiangpeng Dong Pei Xiong Longbin Guo Shengjie Yu Chunping Han Hui Ning Kang Liu Huiming Zou Ling Zhang Zhiling |
| Author_FL_xml | – sequence: 1 fullname: Zou Xiangpeng – sequence: 2 fullname: Ning Kang – sequence: 3 fullname: Zhang Zhiling – sequence: 4 fullname: Zou Ling – sequence: 5 fullname: Xiong Longbin – sequence: 6 fullname: Peng Yulu – sequence: 7 fullname: Zhou Zhaohui – sequence: 8 fullname: Liu Huiming – sequence: 9 fullname: Yu Chunping – sequence: 10 fullname: Dong Pei – sequence: 11 fullname: Guo Shengjie – sequence: 12 fullname: Han Hui – sequence: 13 fullname: Zhou Fangjian |
| Author_xml | – sequence: 1 fullname: 邹湘鹏 – sequence: 2 fullname: 宁康 – sequence: 3 fullname: 张志凌 – sequence: 4 fullname: 邹玲 – sequence: 5 fullname: 熊龙滨 – sequence: 6 fullname: 彭毓璐 – sequence: 7 fullname: 周朝晖 – sequence: 8 fullname: 刘辉明 – sequence: 9 fullname: 俞春萍 – sequence: 10 fullname: 董培 – sequence: 11 fullname: 郭胜杰 – sequence: 12 fullname: 韩辉 – sequence: 13 fullname: 周芳坚 |
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| Keywords | 肾肿瘤 Radical nephrectomy Survival analysis 根治性肾切除 生存分析 Renal neoplasms |
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| Publisher | 中山大学肿瘤防治中心 华南恶性肿瘤防治全国重点实验室 肿瘤医学协同创新中心泌尿外科，广州 510060%中山大学肿瘤防治中心 华南恶性肿瘤防治全国重点实验室 肿瘤医学协同创新中心影像科，广州 510060 |
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| Title | 单中心1 367例根治性肾切除肾癌患者的远期生存分析 |
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