基于SEER数据库的肾集合管癌的生存分析研究

摘要

目的 探讨影响肾集合管癌(CDC)患者预后的因素. 方法 回顾性分析SEER数据库中2004年至2015年收录的确诊并获随访的341例CDC患者的临床、病理及随访资料,其中193例纳入研究.应用KapLan‐M eier生存分析法计算患者的总体生存率和肿瘤特异性生存率,应用Log‐rank检验比较生存率差异并采用Cox比例风险回归模型分析影响预后的因素. 结果 CDC患者1 、3和5年总体生存率分别为61?0%、36?6% 和31?2%,1 、3和5年肿瘤特异性生存率分别为62?4%、41?0% 和37?5%.单因素分析结果显示,肿瘤大小、Grade分级、AJCC分期、T 分期、淋巴结转移、远处转移以及肾切除术是影响患者生存时间的因素.临床上肿瘤分期以AJCC Ⅲ期、Ⅳ期多见(137／193) ,组织学分级以Grade Ⅲ级、Ⅳ级多见(156／193) . 结论 CDC是一类罕见的肾细胞癌,具有高度恶性的生物学行为,预后差. Grade分级≥ Ⅲ级、病理分期≥T3 期、发生远处转移是影响CDC患者预后的独立危险因素,实施肾切除术是独立保护因素.%Objective To expLore the prognostic factors for renaL coLLecting duct carcinoma (CDC)? Methods T he cLinicaL ,pathoLogicaL and foLLow‐up data of a cohort of 341 CDC patients di‐agnosed and foLLowed up from 2004 to 2015 in SEER database were retrospectiveLy anaLyzed? OveraLL survivaL rate and cancer‐specific survivaL rate were caLcuLated through KapLan‐M eier method and the survivaL rate difference was assessed with Log‐rank test .Besides ,the infLuencing factors of progno‐sis were anaLyzed with Cox proportionaL risk modeL? ResuLts AnaLysis of the research data showed that one‐year ,three‐year and five‐year overaLL survivaL rates of CDC patients were 61?0%,36?6%and 31?2%,respectiveLy ,and one‐year ,three‐year and five‐year cancer‐specific survivaL rates were 62?4%,41?0% and 37?5%,respectiveLy? Univariate anaLysis showed that tumor size ,Grade cLassi‐fication ,AJCC stage ,T stage ,Lymph node metastasis ,distant metastasis and surgery were signifi‐cant prognostic factors of CDC? The majority of CDC patients are in the AJCC Ⅲ and the AJCC Ⅳstage (137／193) ,and most cases are in the Grade Ⅲ and the Grade Ⅳ LeveL (156／193 ). ConcLu‐sions As a subtype of renaL cancer ,CDC show s a high degree of maLignancy and bad prognosis?Distant metastasis ,Grade Ⅲ LeveL and above ,T3 stage and above were independent risk factors af‐fecting the survivaL time of CDC patients ,and the impLementation of surgery was an independent protective factor?