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肾细胞癌不同病理组织亚型与预后的关系

Comparison of the prognosis of subgroup of renal cell carcinoma of different pathological types

摘要:

目的:探讨肾癌术后病理组织分型对预后的影响。方法:回顾性分析华西医院2002年7月至2014年6月行手术治疗的1 346例肾癌患者的临床病理资料,男839例,女507例;术时年龄(55.1±13.4)岁;美国东部肿瘤协作组(ECOG)评分0分911例,≥1分435例;透明细胞癌1 120例,乳头状细胞癌62例,嫌色细胞癌79例,其他类型肾癌85例;T 1、T 2、T 3、T 4期分别为1 019、177、102、48例;WHO核分级高、中、低分化及未知分别为587、530、85、144例;肿瘤直径<5、≥5且<10、≥10 cm及未知分别为685、541、104、16例;合并坏死200例;合并肉瘤样分化27例。同时收集2000—2017年SEER数据库中80 439例肾癌术后病例的资料,男51 371例,女29 068例;年龄(60.9±12.4)岁;白色人种66 261例,黑色人种86 80例,亚裔及北美原住民5 022例,未知人种476例;透明细胞癌62 600例,乳头状细胞癌12 170例,嫌色细胞癌4 354例,其他类型肾癌1 315例;T 1、T 2、T 3、T 4期分别为55 332、8 687、15 516、904例;WHO核分级高、中、低分化分别为52 323、22 700、5 416例;肿瘤直径<5、≥5且<10、≥10 cm分别为46 741、25 760、7 938例。分别分析华西医院和SEER两组人群中性别、年龄等临床因素以及肿瘤组织亚型、分期、分级等病理因素对预后的影响;在SEER不同人种中进行亚组分析,了解不同组织亚型肾癌术后的预后差异,并与华西医院病例进行比较;将华西医院病例带入UISS、SSIGN、Leibovich 3种肾癌预后预测模型,通过一致性指数(c-index)分析不同模型对华西医院病例及亚组的预测价值。 结果:华西医院病例1 346例生存分析结果显示,嫌色细胞癌、透明细胞癌、乳头状细胞癌、其他类型肾癌的5年总生存率分别为97.5%、87.9%、79.7%、68.4%;术时年龄>50岁、ECOG评分≥1分、肿瘤分期偏晚、核分级差、肿瘤直径大、合并坏死及肉瘤样分化均提示预后不佳( P<0.05)。SEER数据库80 439例生存分析结果显示,嫌色细胞癌、乳头状细胞癌、透明细胞癌、其他类型肾癌的5年总生存率分别为96.3%、92.5%、88.9%、85.3%;术时年龄>50岁、男性、亚裔及北美原住民、肿瘤分期偏晚、核分级差、肿瘤直径大均提示预后不佳( P<0.05)。SEER数据库亚裔及北美原住民亚组分析结果显示,嫌色细胞癌、透明细胞癌、乳头状细胞癌、其他类型肾癌5年总生存率分别为95.1%、88.6%、86.7%、80.2%。外部验证结果显示,SSIGN、Leibovich、UISS预测模型的精度分别为0.763~0.781、0.725~0.752、0.641~0.660。在4种病理类型亚组分析中,预测模型UISS对嫌色细胞癌、透明细胞癌、乳头状细胞癌、其他类型肾癌的预测精度分别为0.670~0.781、0.649~0.661、0.620~0.644、0.567~0.613;预测模型SSIGN和Leibovich对嫌色细胞癌、乳头细胞癌亚组、透明细胞癌、其他类型肾癌的预测精度分别为0.733~0.903、0.785~0.834、0.731~0.767、0.657~0.776。 结论:肾癌术后病理组织亚型对预后的影响可能存在人种差异性,在华西医院病例和SEER数据库亚裔及北美原住民人群中,嫌色细胞癌预后最优,乳头状细胞癌较透明细胞癌稍差,其他类型肾癌预后最差。SSIGN和Leibovich预测模型对华西医院病例的预测价值高于UISS,且对嫌色细胞癌的预测效能较好。

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abstracts:

Objective:To study and compare the prognosis of different pathological subtypes of renal cell carcinoma (RCC).Methods:Clinicopathological and prognostic data of 1 346 cases of postoperative renal cell carcinoma during July 2002 to June 2014 in West China Hospital were collected retrospectively.There were 839 males and 507 females, aged (55.1±13.4)years, including 1 120 cases of clear cell RCC, 62 cases of papillary RCC, 79 cases of chromophobe RCC and 85 cases of the other pathological types respectively. ECOG 0 and ≥1 were 911 and 435 cases, with; T 1, T 2, T 3 and T 4 of 1 019, 177, 102 and 48 cases respectively; WHO nuclear grade for well, intermediate, poor differentiation and unknown were 587, 530, 85 and 144 cases separately.Tumor size <5cm, 5-10cm, ≥10cm and unknown were 685, 541, 104 and 16 cases.Combined with necrosis or sacromatoid differentiation were 200/1 146 and 27/1 319 cases separately. Meanwhile, data of 80 439 cases from Surveillance, Epidemiology, and End Results Program (SEER) were also collected.There were 51 371 males and 29 068 females, aged (60.9±12.4) years; , with 66 261, 8 680, 5 022 and 476 cases of White, Black, Asian, American native, or unknown race separately. There were 62 600 of clear cell RCC, 12 170 of papillary RCC, 4 354 of chromophobe RCC and 1 315 of other pathological types, with T 1, T 2, T 3 and T 4 of 55 332, 8 687, 15 516 and 904 cases respectively; WHO nuclear grade for well, intermediate and poor differentiation were 52 323, 22 700 and 5 416 cases separately.Tumor size <5cm, 5-10cm, ≥10cm were 46 741, 25 760 and 7 938 cases respectively. Kaplan-Meier survival analysis were performed on these two group of cases, with different factors between subgroups (gender, age, pathological types, tumor stage, size and nuclear grade) evaluated by log-rank test. To evaluate accuracy of outcome prediction models of SSIGN, Leibovich and UISS score, concordance index of these models were evaluated. Results:In 1 346 cases of our cohort, those with chromophobe RCC were well prognostic, survival were relatively better in clear cell RCC than that of papillary RCC, and worst prognosis were demonstrated in those with other types of RCC (5 year overall survival rate: 97.5%, 87.9%, 79.7% and 68.4% separately). Poor prognosis were seen in those older than 50 years, with poor T stage or nuclear grade, large tumor size and tumors with necrosis or sacromatoid differentiation ( P<0.05). In 80 439 seer cases, the best prognosis was also seen in chromophobe RCC and the worst in other type of RCC separately (5 year overall survival rate: 96.3% and 85.3%). In addition, longer survival was seen in papillary RCC than clear cell RCC (5 year overall survival rate: 92.5% and 88.9%). However, similar results with our cohort were seen in Asian and American native subgroup of SEER cases (95.1%, 88.6%, 86.7%, 80.2% for chromophobe, clear cell, papillary and other types of RCC respectively). Poor prognosis were seen in those older than 50 years, males, Asian/ American Indian, poor T stage or nuclear grade and large tumor size ( P<0.05). Concordance index for SSIGN, Leibovich and UISS models in our cohort were 0.763-0.781, 0.725-0.752 and 0.641-0.660, respectively. The chromophobe RCC subgroup was relative better based on predictive value of prognosis models(c-index of UISS of 0.670-0.781, SSIGN and Leibovich of 0.733-0.903). Conclusions:In Asian RCC population, prognosis of chromophobe RCC is best, clear cell RCC is slightly better than papillary RCC, and the prognosis of other types of RCC is the worst. Concordance index of SSIGN and Leibovich in our cohort were higher than that of UISS, and the use value for predictive model was better in the chromophobe RCC subgroup.

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作者: 邵彦翔 窦卫超 胡旭 任尚青 杨振 Lia Thongher 刘健帮 熊三钞 杨为潇 魏强 曾浩 李响
期刊: 《中华泌尿外科杂志》2021年42卷2期 89-96页 ISTICPKUCSCDCA
栏目名称: 临床研究
DOI: 10.3760/cma.j.cn112330-20200430-00344
发布时间: 2021-04-06
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