摘要目的 探讨肾细胞癌患者的生存预后特征.方法 收集2002年1月至2012年12月在北京协和医院泌尿外科接受手术的1 497例肾细胞癌患者临床资料,通过电话和病历查询相结合的方式随访患者的术后诊疗信息、疾病进展和生存资料,用乘积极限法比较不同类型患者的生存情况,用Cox等比例风险模型分析影响肾细胞癌患者预后的因素.其中1 326例获得随访.结果 男性899例,女性427例.中位年龄[M(QR)]为54(18)岁.肿瘤分期T1期1 049例(79.11％),T2期139例(10.48％)、T3期125例(9.43％)、T4期13例(0.98％).接受肾癌根治手术742例(55.96％),保留肾单位手术584例(44.04％).肾透明细胞癌1153例(86.95％),非透明细胞癌173例(13.05％).随访0.5～147.0个月,中位随访时间为43.6个月.147例出现肾癌相关进展,中位无进展生存时间为18.2个月.64例发生肾癌相关死亡,中位肿瘤特异性总生存时间为27.7个月.T1期肾细胞癌的1、5、10年肿瘤特异性生存率分别为99.61％、97.24％、92.08％;T2期肾细胞癌的1、5、10年肿瘤特异性生存率分别为98.51％、92.01％、85.08％;T3 +T4期肾细胞癌的1、5、10年肿瘤特异性生存率分别为92.40％、77.99％、42.56％.多因素Cox回归分析结果显示,肺部症状、骨症状、淋巴结转移、病理类型、病理肉瘤样改变、术后进展类型是影响肿瘤特异性生存时间的主要预后因素(P＜0.05).结论 手术是肾细胞癌患者的主要治疗方式.不同T分期患者的生存情况不同.T分期还可影响肾细胞癌患者的肿瘤进展情况,而N分期、肺部和骨症状、病理类型、肉瘤样改变和术后肾细胞癌转移会影响肾细胞癌患者死亡情况.

abstractsObjective To explore how clinical features of renal cell carcinoma (RCC) relate to cancer patients' prognosis and survival.Methods A total of 1 497 renal cell carcinoma patients received surgical treatments in Department of Urology,Peking Union Medical College were admitted between January 2002 and December 2012.Telephone interviews and complimentary medical records review were carried out to acquire follow-up data,including post-surgery adjuvant therapy,disease progression and survival.Results There were 1 326 of all 1 497 RCC cases successfully followed up,including 899 male and 427 female cases.The median age was 54 (18) years (M(QR)).There were 1 049 T1 cases (79.11％),139 T2 cases (10.48％),125 T3 cases (9.43％),and 13 T4 cases (0.98％).As for types of surgery,there were 584 (44.04％) nephron-sparing surgery cases,and 742 (55.96％) radical nephrectomy cases.As for pathological subtypes,it included 1 153 (86.95％) clear cell renal cell carcinoma cases,and 173 (13.05％) non-clear cell renal cell carcinoma cases.Median length of follow-up was 43.6 months.During follow-up,147 patients developed RCC related progression,with a median progression free survival of 18.2 months.Sixty-four patients died from RCC related progression,with a median cancer specific survival (CSS) of 27.7 months.Results of data analysis showed that CSS rates of 1-,5-,10-year of T1 stage postsurgical RCC were 99.61％,97.24％,92.08％,respectively; CSS rates of 1-,5-,10-year of T2 stage were 98.51％,92.01％,85.08％,respectively; and CSS rates of 1-,5-,10-year of T3-4 stage were 92.40％,77.99％,42.56％,respectively.Multivariable Cox regression analysis showed that signs of lung metastasis,signs of bone metastasis,tumor N stage,pathological subtype,microscopic sarcomatoid changing,and types of progression were major risk factors for RCC cancer specific survival (P ＜ 0.05).Conclusions Surgery is the primary choice of treatment in RCC.The survival is not same with different T stage.T stage affects the progression of renal cell carcinoma.N stage,lung and bone symptoms,pathological type,sarcomatoid changes and postoperative metastasis of renal cell carcinoma will affect the mortality of patients.