术前血清胱抑素C水平对手术的肾癌患者预后的影响

目的探讨术前血清胱抑素C(Cystatin C,Cys-C)水平对肾癌患者预后的影响。方法回顾性分析2013年1月至2016年12月于徐州医科大学附属医院行根治性/部分肾切除术治疗的354例肾癌患者的临床病理和随访资料。根据受试者工作特征曲线(ROC)确定Cys-C的最佳临界值,将其分为高Cys-C组和低Cys-C组。运用Kaplan-Meier、Log-rank检验分析两组患者的总生存率和肿瘤特异性生存率的差异,通过单因素和多因素Cox模型分析影响患者总生存和肿瘤特异性生存的因素。结果共纳入354例患者,其中高Cys-C组36例、低Cys-C组318例。与低Cys-C组相比,高Cys-C组患者年龄更大、肿瘤分期更晚及尿素、肌酐、尿酸水平更高(P均<0.05),但肾小球滤过率相对较低(P<0.05)。Kaplan-Meier结果显示高Cys-C组与低Cys-C组5年总生存率分别为56.7%和96.2%,5年肿瘤特异性生存率分别为64.0%和96.5%(P均<0.05)。Cox多因素分析结果显示术前高Cys-C水平为肾癌患者术后总生存(HR:10.513,95%CI:2.539~43.522,P=0.001)和肿瘤特异性生存(HR:4.944,95%CI:1.017~24.043,P=0.048)的独立影响因素。结论肾癌患者术前血清Cys-C水平升高提示术后预后不良。

Effects of preoperative serum cystain C level on the prognosis of patients with renal cell carcinoma treated with surgery

Objective To investigate the effects of preoperative serum cystain C(Cys-C) level on the prognosis of patients with renal cell carcinoma(RCC).Methods The clinicopathologic and follow-up data of 354 RCC patients treated with radical/partial nephrectomy during 2013 and 2016 were reviewed.Patients were divided into high Cys-C and low Cys-C groups according to receiver operating characteristic(ROC) curve.The differences in overall survival(OS) and cancer-specific survival(CSS) between the two groups were analyzed with Kaplan-Meier and Log-rank tests.The influencing factors of OS and CSS were analyzed with univariate and multivariate Cox proportional hazards regression analysis.Results There were 36 patients in high Cys-C group and 318 in low Cys-C group.Patients in the high Cys-C group were older,had more advanced tumor stage and higher urea,creatinine and uric acid levels(all P<0.05),but had a lower glomerular filtration rate(P<0.05).KaplanMeier and Log-rank tests showed the 5-year OS was 56.7% in the high Cys-C group and 96.2% in the low Cys-C group;the 5-year CSS was 64.0% in the high Cys-C group and 96.5% in the low Cys-C group(all P<0.05).Multivariate Cox analysis identified high preoperative Cys-C level was the independent influencing factor of OS(HR:10.513,95% CI:2.539-43.522,P=0.001) and CSS(HR:4.944,95%CI:1.017-24.043,P=0.048).Conclusion Preoperative elevation of Cys-C in RCC patients indicates poor prognosis.