肾细胞癌中微血管侵犯对于预后影响.docVIP

肾细胞癌中微血管侵犯对于预后影响 　　[摘要] 目的 探讨微血管侵犯（MVI）对肾细胞癌（RCC）患者预后的影响。 方法 回顾2002年1月～2014年6月武汉市中心医院收治的RCC患者的临床资料，将肿瘤病理中存在MVI的51例患者（T1～T3，不包括肾静脉及下腔静脉受侵）纳入观察组，同期病理无MVI的相同数目患者纳入对照组，Kaplan-Meier法比较两组无病生存率（DFS）和肿瘤特异性生存率（CSS），Cox模型法分析有MVI的RCC患者的预后影响因素。 结果 观察组的5年CSS为86%，对照组的5年CSS为84%。Kaplan-Meier分析显示，两组在CSS和DFS方面比较差异无统计学意义（P 0.05）。Cox回归分析提示，细胞分级和TNM分期与实验组和观察组的CSS相关，相对危险度分别为3.535和2.219（P 0.05）；肿瘤的细胞分级和TNM分期亦与观察组的DFS相关，相对危险度分别为7.333和2.029（P 0.05）。 结论 MVI对局限性RCC的预后无显著影响。肿瘤的细胞分级、TNM分期越高，患者的预后越差。 　　[关键词] 肾细胞癌；微血管侵犯；预后；病理 　　[中图分类号] R737.1 [文献标识码] A [文章编号] 1673-7210（2017）09（c）-0085-04 　　[Abstract] Objective To investigate the effect of microvascular invasion （MVI） on prognosis in renal cell carcinoma （RCC）. Methods The clinical data of patients with RCC which be collected from January 2002 to June 2014 in Central Hospital of Wuhan were analyzed. 51 patients （T1-T3， without renal vein or inferior vena cava invasion） with MVI confirmed by pathology and the same number patients without MVI were enrolled in this study. Disease free survival （DFS） and cancer specific survival （CSS） were analyzed by Kaplan-Meier. Prognostic factors of patients with MVI were analyzed by Coxs model. Results 5-year CSS rate of patients with or without MVI were 86% and 84%. There were no obviously difference of CSS and DFS between two groups（P 0.05）. But the tumor grade and TNM staging were confirmed to be the prognostic factors of CSS， and the relative risk （RR） value were 3.535 and 2.219 （P 0.05）. It was also showed that tumor grade and TNM staging were prognostic factors of DFS， and RR value were 7.333 and 2.029 （P 0.05）. Conclusion MVI appear to have no effect on prognosis in localized RCC patients. Higher grade and TNM staging are related to the poor prognosis. 　???[Key words] Renal cell carcinoma； Microvascular invasion； Prognosis； Pathology 　　?I细胞癌（RCC）占成人恶性肿瘤的2%～3%，且其发病率以2%的速度逐渐上升[1-2]。约70%的患者在诊断时为局限性或局部进展性肾癌，但20%～40%的局限性肾癌患者在手术治疗后会出现复发或转移[3-4]。当前，被广泛证实的关于局限性肾癌的预后因素包括病理类型、细胞分级、肿瘤大小、肾周侵犯和大血管侵犯。其中下腔静脉