摘要
目的探讨肾透明细胞癌(ccRCC)患者术前CT征象影响总生存期的独立危险因素并绘制列线图。方法回顾性分析空军军医大学第一附属医院2011年10月至2015年12月术前行CT扫描并最终经病理学证实的ccRCC患者238例。由两名影像科医生对每例患者的CT征象进行评价,并收集患者的一般资料、肾功能检查以及世界卫生组织/国际泌尿病理协会(WHO/ISUP)分级。绘制Kaplan-Meier生存曲线,采用log-rank检验比较生存率。采用Cox比例风险回归进行单变量和多变量分析,并根据多变量分析结果绘制列线图,采用Bootstrap 1000法内部验证后计算C-指数。结果238例患者经3~74个月随访后,死亡组32例,截尾组206例。死亡组患者的肿瘤直径为(65.70±27.29)mm,大于截尾组的(46.25±26.16)mm,差异有统计学意义(t=-3.889,P<0.001)。死亡组患者肿瘤坏死(χ2=45.716,P<0.001)、区域淋巴结肿大(χ2=43.342,P<0.001)、肾周脂肪侵犯(χ2=19.324,P<0.001)的发生率均高于截尾组患者。不同肿瘤直径的ccRCC患者其生存率差异有统计学意义(χ2=17.108,P<0.001)。肿瘤组织出现坏死患者的生存率较无坏死患者低(χ2=48.195,P<0.001);区域淋巴结肿大患者的生存率低于无区域淋巴结肿大的患者(χ2=47.232,P<0.001);出现肾周脂肪侵犯患者的生存率低于未侵犯的患者(χ2=19.964,P<0.001)。不同WHO/ISUP分级ccRCC患者的生存率差异有统计学意义(χ2=27.765,P<0.001)。多变量Cox比例风险回归分析结果显示,CT征象中的肿瘤直径(HR=2.90,95%CI为1.37~6.14,P=0.006)、坏死(HR=8.88,95%CI为3.33~23.69,P<0.001)及区域淋巴结肿大(HR=4.48,95%CI为2.04~9.86,P<0.001)是ccRCC患者死亡的独立危险因素。列线图的C-指数为0.870。结论术前CT征象与ccRCC患者的生存率存在相关性,其中肿瘤直径、肿瘤出现坏死以及区域淋巴结肿大是其死亡的独立危险因素,其列线图具有较高的准确性。
Objective To explore the independent risk factors of preoperative CT findings affecting the overall survival of patients with clear cell renal cell carcinoma(ccRCC)and to draw a nomogram.Methods The retrospective study was performed on 238 patients with ccRCC who underwent preoperative CT scan and were pathologically confirmed in First Affiliated Hospital of Air Force Medical University from October 2011 to December 2015.CT findings of each patient were evaluated by two radiologists,and general information,renal function examination,and World Health Organization/International Society for Urology and Pathology(WHO/ISUP)grading were collected.The Kaplan-Meier survival curve was plotted,and survival rates were compared using log-rank test.Cox proportional hazard regression was used for univariate and multivariate analysis,and the nomogram was drawn according to the results of multivariate analysis,and the C-index was calculated after internal validation by Bootstrap 1000.Results After 3-74 months of follow-up for 238 patients,32 cases were in the death group and 206 cases were in the censored group.The tumor diameter of the death group[(65.70±27.29)mm]was larger than that of the censored group[(46.25±26.16)mm],with a statistically significant difference(t=-3.889,P<0.001).The incidence rate of tumor necrosis(χ2=45.716,P<0.001),regional lymph node enlargement(χ2=43.342,P<0.001)and perirenal fat invasion(χ2=19.324,P<0.001)in the death group were higher than those in the censored group.Survival rates were different in patients with different tumor diameter of ccRCC,with a statistically significant difference(χ2=17.108,P<0.001).The survival rate of patients with tumor necrosis was lower than those without necrosis(χ2=48.195,P<0.001).The survival rate of patients with regional lymph node enlargement was lower than those without regional lymph node enlargement(χ2=47.232,P<0.001).The survival rate of patients with perirenal fat invasion was lower than those without perirenal fat invasion(χ2=19.964,P<0.001).Survival
作者
王佳丽
韩冬
陈英
张亚敏
艾美梅
Wang Jiali;Han Dong;Chen Ying;Zhang Yamin;Ai Meimei(Department of Cardiology,First Affiliated Hospital of Air Force Medical University,Xi′an 710023,China;Fourth Department of Oncology,Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine,Xianyang 712021,China;Department of Emergency,First Affiliated Hospital of Air Force Medical University,Xi′an 710023,China)
出处
《国际肿瘤学杂志》
CAS
2020年第8期480-486,共7页
Journal of International Oncology
