肾癌合并静脉瘤栓的临床病理特征及其对预后的影响

摘要

目的 探讨肾癌合并静脉瘤栓的临床病理特征及其对预后的影响.方法 回顾分析2009年1月到2015年1月期间25名行手术治疗的肾癌合并静脉瘤栓的患者,根据患者随访期间是否存活分为死亡组(16例)和生存组(9例),应用SPSS 11.5统计学软件对患者进行Spearman相关性分析、多因素COX死亡回归模型多因素预后分析和Kaplan-Meier生存分析,探讨影响肾癌合并静脉瘤栓预后的各临床因素.结果 生存组患者和死亡组患者的肿瘤最大直径肿(t=-0.409,P=0.000)、无瘤生存时间(t=2.174,P=0.040)、手术时间(t=-2.734,P=0.012)、脂肪囊有无转移(χ2=7.667,P=0.011)、和TNM分期(χ2=6.850,P=0.033)差异有统计学意义.多因素COX分析可见肿瘤脂肪囊浸润是肾癌合并静脉瘤栓患者发生死亡事件的影响因素(OR=14.251,95%CI=1.324~153.403).采用Kaplan-Meier函数可见有脂肪囊浸润组患者和无脂肪囊浸润组患者的生存时间差异有统计学意义[(16.2±3.4)个月vs(45.6±5.4)个月,P=0.001].结论 肾肿瘤最大直径、无瘤生存时间、手术时间、肾癌TNM分期、脂肪囊有无浸润是影响肾癌伴腔静脉癌栓患者术后生存的影响因素,有无肾周脂肪囊受侵是影响肾癌合并静脉癌栓生存预后的重要因素.%Objective To explore the relationship between clinicopathological characteristics and prognosis in patients with renal cell carcinoma with venous tumor thrombus.MethodsA retrospective analysis was used to analyze the clinicopathological characteristics of 25 patients with renal cell carcinoma treated by surgery for renal cell carcinoma treated by surgery from January 2009 to January 2015. Sperman analysis,multivariate COX regression model and Meier-Kaplan survival analysis were performed by using SPSS 11.5 software. ResultsUnivariate analysis showed there was a significant difference between the maximum radius of tumor (t=-0.409,P=0.000),disease-free survival(t=2.174,P=0.040),operative time(t=-2.734,P=0.012),whether there was adipose capsule metastasis(χ2=7.667,P=0.011),and TNM staging(χ2=6.850,P=0.033) of survival group and dead group. Multivariate COX analysis showed the adipose capsule invasion was a factor of death event in the patients with renal cell carcinoma with vein tumor thrombus(OR=14.251,95%CI=1.324~153.403). There were significant differences in survival time between patients with fat capsule invasion group and no fat capsule invasion group by using Kaplan-Meier curve[(16.2±3.4)months vs.(45.6±5.4)months,P=0.001]. ConclusionThis study showed that the maximum tumor radius,tumor thrombus grading,renal tumor TNM stage,perirenal fat invasion were the influencing factors for postoperative survival in patients with renal cell carcinoma with inferior vena cava tumor thrombus. Patient with renal capsule invasion is an important prognostic factor for the survival of renal cell carcinoma with venous tumor thrombus.