不同侵袭模式对T3a肾细胞癌患者预后的影响

doi:10.3969/j.issn.1006-7795.2023.03.013

摘要/Abstract

摘要： 目的通过探索肾外脂肪浸润（extrarenal fat invasion,EFI）和肾静脉浸润（renal vein invasion,RVI）对T3a肾细胞癌（renal cell carcinoma,RCC）患者预后的影响，为临床最佳治疗提供依据。方法从监测、流行病学和最终结果(Surveillance, Epidemiology, and End Results， SEER)数据库中获取8 965例T3a期RCC患者的基本信息和临床病理信息，通过Logistic回归分析发生RVI的主要危险因素。按照1∶1进行倾向性匹配，消除其他危险因素干扰，比较EFI组和RVI组患者的总生存期（overall survival,OS）和癌症特异性生存期（cancer specific survival,CSS）。通过Cox回归分析影响T3aRCC患者OS和CSS的独立危险因素。结果本研究纳入T3a患者8 965例，其中EFI组患者4 803例（53.6%），RVI组患者4 162例（46.4%）。RVI患者更容易发生骨（6.2% vs 4.9%）、肺（15.4% vs 9.0%）、肝（2.5% vs 1.5%）等重要脏器的转移(P<0.05)。年龄、性别、组织学类型、肿瘤大小、N分期、M分期是影响发生RVI的独立危险因素（均P<0.05）。相比于EFI组，RVI组患者的5年总生存率（64.0% vs 66.6%，P=0.023）和癌症特异性生存率（72.1% vs 75.1%，P=0.005）更差。RVI是影响T3a患者OS和CSS的独立影响因素(P<0.05)。结论虽然EFI和RVI均属于T3a期，但RVI患者远期预后更差，对发生RVI的患者，应加强随访和复查，以改善患者预后。

关键词: 肾细胞癌, 肾外脂肪浸润, 肾静脉浸润, 预后

Abstract: Objective To explore the effect of extrarenal fat invasion (EFI) and renal vein invasion (RVI) on the prognosis of T3a renal cell carcinoma (RCC) patients, in order to provide a better therapy scheme. Methods The basic and clinicopathological information of 8 965 patients with T3a stage was collected from the Surveillance, Epidemiology, and End Results （SEER） database, to analyze the main risk factor of RVI by Logistic regression. The overall survival (OS) and cancer-specific survival (CSS) of patients in the EFI and RVI groups were compared after propensity matching (1∶1). Independent risk factor affecting OS and CSS in T3a RCC patients were analyzed by Cox regression. Results A total of 8 965 T3a patients were enrolled in this study, including 4 803 (53.6%) patients in the EFI group and 4 162 (46.4%) patients in the RVI group. Patients with RVI were more likely to develop bone (6.2% vs 4.9%), lung (15.4% vs 9.0%), and liver (2.5% vs 1.5%) metastases (P<0.05). Age, gender, histological type, tumor size, N stage, and M stage were independent risk factors for RVI (all P<0.05). Compared with the EFI group, patients in the RVI group had a worse 5-year OS (64.0% vs 66.6%, P=0.023) and CSS (72.1% vs 75.1%,P=0.005). RVI was an independent factor affecting OS and CSS in T3a patients (P<0.05). Conclusion Although EFI and RVI belong to T3a stage, the long-term prognosis of patients with RVI is worse than with EFI. For patients with RVI, follow-up examination should be strengthened to improve the prognosis.

Key words: renal cell carcinoma, extrarenal fat invasion, renal vein invasion, prognosis

中图分类号:

R737.11

王润锦, 叶小波, 张玉冬, 朱光艺, 杨坤, 牛亦农. 不同侵袭模式对T3a肾细胞癌患者预后的影响[J]. 首都医科大学学报, 2023, 44(3): 439-448.

Wang Runjin, Ye Xiaobo, Zhang Yudong, Zhu Guangyi, Yang Kun, Niu Yinong. Effect of different invasion patterns on the prognosis of patients with T3a renal cell carcinoma[J]. Journal of Capital Medical University, 2023, 44(3): 439-448.

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