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术前AST和AST/ALT评估非转移性肾细胞癌伴静脉癌栓患者预后的价值

Preoperative AST and AST/ALT ratio predict clinical outcome in patients with non-metastatic renal cell carcinoma with tumor thrombus

摘要:

目的:探讨术前天冬氨酸转氨酶(AST)和天冬氨酸转氨酶/丙氨酸转氨酶比值(AST /ALT)评估非转移性肾细胞癌伴静脉癌栓患者预后的临床价值。方法:回顾性分析北京大学第三医院2015年2月至2018年12月手术治疗的80例肾细胞癌合并静脉癌栓患者的临床资料。男56例,女24例;中位年龄58岁(15~83岁)。Mayo分级0级癌栓17例,Ⅰ级癌栓24例,Ⅱ级癌栓22例,Ⅲ级癌栓12例,Ⅳ级癌栓5例。术前AST中位值19 U/L(8~226 U/L),AST/ALT中位值1.3(0.4~3.3)。所有患者接受根治性肾切除术或减瘤性肾切除术联合癌栓取出术。通过受试者工作特征曲线分析AST/ALT,以约登指数最大值所对应的数值为临界值,分为高AST/ALT组和低AST/ALT组。采用Kaplan-Meier法及log-rank检验得出高、低AST/ALT组的生存曲线,采用单因素及多因素Cox回归分析影响非转移性肾癌伴静脉癌栓患者预后的独立因素。结果:术后病理回报透明细胞癌70例,非透明细胞癌10例;低Fuhrman分级(1~2级)30例,高Fuhrman分级(3~4级)50例。术前AST在有、无淋巴血管侵犯中差异有统计学意义( P=0.040),但在不同性别、年龄、Mayo分级、病理类型、Fuhrman分级和淋巴结转移情况间差异无统计学意义(均 P>0.05);AST/ALT在不同年龄中差异有统计学意义( P=0.025)。术后随访时间0~44个月,平均14.7个月,随访期内肿瘤特异性死亡11例(13.8%)。单因素Cox回归分析结果显示,Fuhrman分级( P=0.007)、淋巴结转移( P=0.019)、血红蛋白( P=0.001)、碱性磷酸酶(ALP, P=0.001)、AST( P=0.004)和AST/ALT( P=0.038)是肿瘤特异性生存率(CSS)的危险因素。进一步进行多因素分析,考虑到AST和AST/ALT有潜在相关性,排除AST影响后,多因素Cox回归分析结果显示,高核分级( HR=3.049,95% CI 1.292~7.196, P=0.011)、高ALP( HR=1.018,95% CI 1.007~1.029, P=0.001)、高AST/ALT( HR= 4.094,95% CI 1.064~15.759, P=0.04)与不良CSS相关;排除AST/ALT影响后,多因素Cox回归分析结果显示,高核分级( HR=5.836,95% CI 1.867~18.240, P=0.002)、高AST( HR=1.040,95% CI 1.017~1.062, P<0.001)与不良CSS相关。 结论:非转移性肾细胞癌伴静脉癌栓患者中,高AST/ALT和高AST预示着不良病理类型,且CSS较差。

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abstracts:

Objective:To explore the value of preoperative aspartate transaminase(AST) and aspartate transaminase/alanine transaminase ratio(AST/ALT)for predicting the prognosis in patients with non-metastatic renal cell carcinoma with tumor thrombus.Methods:A retrospective analysis was made of the patients with renal cell carcinoma with tumor thrombus in our institution from February 2015 to December 2018. This study included 80 patients, 56 males and 24 females with mean age of 58 years (range 15-83 years). There were 17 in Mayo level 0, 24 Mayo level I, 22 in Mayo level II, 12 in Mayo level III and 5 in Mayo level IV. All the patients received radical nephrectomy or palliative nephrectomy with tumor thrombectomy. The continuous variable of AST/ALT was collected by ROC curve. The maximum value of Youden index was taken as the critical value, and the continuous variables were adjusted to binary variables. Cancer-specific survival (CSS) was calculated according to the Kaplan-Meier analysis and compared by the log-rank test. Cox multivariate regression analysis was used to analyze the independent factors of the prognosis of patients with non-metastatic renal cancer and tumor thrombus.Results:There were 70 cases of clear cell carcinoma, 10 cases of non-clear cell carcinoma, 30 cases of low Fuhrman grade (grade 1&2), and 50 cases of high Fuhrman grade (grade 3&4). AST was 19U/L (8-226 U/L) and AST/ALT was 1.3(0.4-3.3). There was a significant difference in AST between different lymphovascular invasion groups ( P=0.04), but there was no significant difference in sex, age, Mayo classification, pathological type, Fuhrman grade and lymph node metastasis. The difference of AST / ALT between age groups was significant ( P=0.025). The average follow-up time was 14.7 months (0-44 months). During the follow-up, 11 (13.8%) patients died of tumor. Univariate analysis showed that Fuhrman grade ( P=0.007), lymph node metastasis ( P=0.019), hemoglobin ( P=0.001), alkaline phosphatase (ALP, P=0.001), AST ( P=0.004) and AST / ALT ( P=0.038) were risk factors for CSS. In terms of prognosis, considering the potential correlation between AST level and AST/ALT ratio, after excluding AST, multivariate Cox regression analysis showed that high nuclear grade ( HR=3.049, 95% CI 1.292-7.196, P=0.011), high ALP ( HR=1.018, 95% CI 1.007-1.029, P=0.001) and high AST/ALT ratio ( HR=4.094, 95% CI 1.064-15.759, P=0.04) were associated with poor CSS. After excluding AST/ALT ratio, multivariate Cox regression analysis showed that high nuclear grade ( HR=5.836, 95% CI 1.867-18.240, P=0.002) and high AST ( HR=1.040, 95% CI 1.017-1.062, P<0.001) were associated with poor CSS. Conclusions:In patients with non-metastatic renal cell carcinoma with tumor thrombus, high AST/ALT ratio and AST levels indicate poor pathological types and poor prognosis.

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作者: 唐世英 [1] 刘茁 [1] 赵勋 [1] 洪鹏 [1] 王滨帅 [1] 田晓军 [1] 王国良 [1] 张树栋 [1] 张洪宪 [1] 马潞林 [1]
期刊: 《中华泌尿外科杂志》2020年41卷7期 497-502页 ISTICPKUCSCDCA
栏目名称: 临床研究
DOI: 10.3760/cma.j.cn112330-20200221-00103
发布时间: 2020-09-15
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