pT1期肾透明细胞癌术后远期转移的影响因素分析

目的：探讨影响pT1期肾透明细胞癌患者术后远期转移的危险因素。方法：回顾性分析192例pT1期肾透明细胞癌术后5年未出现复发及远处转移患者临床资料。应用Kaplan—Meier单因素分析和COX多因素分析分别讨论性别、年龄、肿瘤部位、临床症状、手术方式、病理学分期、核分级、生物治疗等因素对pT1期肾细胞癌术后远期转移的影响。结果：病理确诊为pT1期肾透明细胞癌的192例患者中，有15例发生了远期转移（7．8％），其中肺转移最常见（6例），中位随访期为8年（5～12年）。经Kaplan—Meier单因素分析及COX多因素分析结果显示：年龄〉150岁，伴有临床症状，病理学分期为pT1b期的患者较年龄〈50岁（P=0．015），无临床症状（P=0．018）以及pT1a期（P=0．008）更易发生远期转移。结论：远期转移为肾细胞癌的特殊生物学行为之一，特别是对于老龄、诊断时有，临床症状和pT1b期肿瘤的患者，即使术后5年未出现转移证据，长期密切的随访仍非常必要。

Independent factors for late recurrence of pT1 clear cell in patients with renal carcinoma after surgery

Objective： To explore the independent prognosis factors in patients who had late recurrence of pT1 clear cell from renal cell carcinoma （RCC） after surgery. Methods： The study retrospectively reviewed 192 RCC patients after surgery and those who had not developed recurrence within 5 years of follow-up period from January 2001 to January 2008 in the institution. Clinical pathological factors such as sex, age,tumor side,presentation, surgery,pathological stage, nuclear grade, treatment, were analyzed by the Kaplan -Meier univariate method and Cox multivariate analysis to find out their effects on the prognosis in PT1 RCC patients. Results： During a median follow-up period of 8 years （range 5-12 years）, late recurrence was observed in 15 of the 192 （7.8%） patients, and pulmonary metastasis was the most common （6 patients）. Univariate and multivariate analyses revealed that with clinical symptoms, patients whose age were more than 50 at pathologic Tlb stage were more likely to suffer late recurrence. Conclusion： Late recurrence is one of the specific biologic behaviors of RCC. Careful long-term follow-up is necessary, especially in aged patients with clinical symptoms or pT1 b tumors even if they have lived without disease for more than 5 years.