青年肾癌患者转移潜能的相关因素分析

目的 探讨与青年肾癌患者预后有关的临床病理、生物学特征,评估与远处转移潜能相关的因素。方法 收集我院泌尿科1986年1月至2007年12月确诊的年龄≤40岁的83例肾癌患者临床资料及随访工作完整,手术方式包括根治术和部分切除术。所有患者按2004年WHO肾实质上皮性肿瘤分类标准进行术后病理复习,包括组织学分类及分级等。免疫组化方法检测VEGFR-1、VEGFR-2、VEGFR-3、PDGFR-α、PDGFR-β、c-kit及PCNA蛋白表达。术后依据病理及转移情况给予化疗和生物治疗。将83例病例按是否出现转移分为2组,将预后相关因素分为临床、病理及生物学因素。计数资料采用x2检验进行5年转移率趋势分析,转移危险因素分析采用多因素COX回归模型。结果 平均随访时间为5年,术后5年转移14例,转移率为16.87 ％(14/83)。临床分期Ⅲ期、病理分级3级的5年转移率最高分别为57.14％(8/14)及78.57％ (11/14);x2=38.042,x2=9.820;P均＜0.01)。转移组的患者VEGFR-3、PCNA阳性表达率高达92.86％ (13/14)、85.71％(12/14)。临床分期的死亡风险率(RR)=3.444(P=0.001)。结论 年轻的肾癌患者预后较差;病理指标中临床分期和病理分级、生物学因素中VEGFR-3及PCNA表达情况与转移关系密切,其中临床分期是与转移相关的惟一独立因素。

Analysis of risk factors related to the metastatic potential of renal cell carcinoma in young patients

Objective To retrospectively analyze the relationship between clinicopathological,biological characteristics and the outcome of renal cell carcinoma(RCC) and evaluate the risk factors related to metastasis in young patients.Methods The data of 83 RCC patients younger than 40-year-old, treated from January 1986 to December 2007 in Tianjin Cancer Hospital,were analyzed retrospectively.The complete follow-up data of the 83 cases were collected.The operative methods included partial and radical surgery.Clinical staging were consistent with the 2004 UICC TNM classification criterion.The histological sections were reviewed.Various biological factors including VEGFR-1, VEGFR-2, VEGFR-3, PDGFR-α, PDGFR-β, c-kit and PCNA were tested by immunohistochemistry staining.The adjuvant radiation therapy, chemotherapy and immunotherapy after operation were carried out on the basis of pathological and biological features.The 83 cases were divided into two groups according to metastasis and non-metastasis status within 5 years.The prognosis related factors including clinical factors, pathological and biological factors were evaluated.Chi-square test was used for the analysis of 5-years metastasis status; and multivariate analysis was carried out using Cox proportional hazards models to assess the independent effect of the metastasis factors (the test standard α = 0.05).Results The 5-year follow-up data showed that the metastasis rate in the 83 cases was 16.87％ (14/83).The Chi-square test results indicated that the patients with clinical stage Ⅲ and grade 3 had the highest metastasis rate (57.14％ and 78.57％respectively,x2 =38.042, x2 = 9.820; Ps ＜ 0.01) .The VEGFR-3 and PCNA positive expression rates were 92.86％ and 85.71％ respectively in metastasis group.The metastatic risk of early stage patients was 3.444 times as much as the advanced stage patients.Conclusion The young patients with clinical advanced renal cell carcinoma had worse outcome.The stage,grade, VEGFR-3 and PCNA expression were the risk factors correlated with the metastasis risk for young RCC patients.TNM stage was an independent predictive risk factor of metastasis in young patients.