乳头状肾细胞癌临床特征及预后相关因素分析(附113例报告)

目的：分析单中心乳头状肾细胞癌(papillary renal cell carcinoma，PRCC)的临床特征，探讨与肾乳头状细胞癌预后相关的临床指标。 方法：通过回顾性分析2005年1月至2015年5月在长海医院住院手术，且经术后病理证实为PRCC的113例患者的临床、病理及随访资料。研究终点为总生存期，生存分析数据采用Kaplan-Meier法进行计算，并用Log-rank法对生存率进行分析比较。采用Cox回归模型进行多因素分析。 结果： 乳头状肾细胞癌占同期收治肾癌患者的4.80%，男女比4.4：1。年龄17-80岁，平均54.5岁。肿瘤平均直径为5.26cm。乳头状肾细胞癌患者1、3、5年生存率分别为100%、98.5%，81.3%。本组中I型乳头状肾细胞癌39例，II型乳头状肾细胞癌55例，未知分型18例。Log-rank检验结果显示，分型（p=0.035）、是否有初始症状（p=0.008）与患者的生存时间有关。Cox多因素回归分析结果显示，是否有区域淋巴结转移（p=0.035）、是否有癌栓（p=0.035）是PRCC患者生存时间的独立影响因素。 结论： PRCC是一种低度恶性的肾细胞癌，分期较早，预后较好。其中，Ⅱ型预后差于I型，有初始症状提示预后不良。
Objective To analyze the characteristics and the prognostic significance of papillary renal cell carcinomas (PRCC). Methods Data about 113 patients with papillary renal cell carcinomas at the time of surgery were retrospectively collected from Changhai Hospital between 2005 and 2015. The prognostic factors were evaluated by Log-rank test．Kaplan-Meier survival curve was used to estimate the survival rate. Results The incidence rate of PRCC was 4.80％ in RCC．And the median age was 54.5 years; M/F ratio was 4.4:1. 55 cases were type I, and 18 were type II, the rest remained unknown.The one-year, 3-year and 5- year survival rates were 100%, 98.5%, 81.3%. The Log rank test showed that type (P=0.035), symptoms at presentation (P=0.008) were associated with survival time. The muhivariable Cox regression model revealed that regional lymph node involvemen（p=0.035）、cancer embolus（p=0.035）were independent predictors of aggressive PRCC. Conlusion PRCC is a distinct type of renal cell carcinoma exhibiting a low degree of malignancy, type II, with initial symptoms indicate worse prognosis