| Objective:The clinical and pathological features of patients with locally advanced renal clear cell carcinoma(T1-2N1M0,T3-4N0-1m0)were analyzed.At the same time,combined with clinical data,the factors of postoperative tumor recurrence,metastasis and long-term survival prognosis of patients were analyzed,so as to provide relevant theoretical basis for postoperative prognosis analysis and treatment of locally advanced renal carcinoma in clinical workMethods:A total of 88 cases of locally advanced patients with clear cell carcinoma of the kidney confirmed by postoperative pathology admitted to the Urology Department of Shandong Provincial Hospital from January 2000 to October 2014 were retrospectively analyzed.The clinical and pathological data of relevant patients were collected from the medical record database of the hospital.The variables included preoperative general condition of the patient,initial diagnosis,stage of lymph node metastasis,tumor size,Fuhrman nuclear grade,level of venous thrombosis,whether the collection system was infiltrated,and whether the tumor was sarcomatoid differentiation.Obtain patient prognosis information by means of telephone WeChat and so on.In this study,statistical survival analysis was performed,and COX univariate and multivariate analyses were performed by Kaplan-Meier method to investigate the independent survival and prognostic factors for tumor recurrence and metastasis in patients with locally advanced renal carcinoma.Finally,the above independent factors were used to construct a prognostic analysis model with 5 risk factors,in order to help clinical work to evaluate the prognosis of locally advanced renal clear cell carcinomaResults:A total of 88 patients with locally advanced stage were collected in this study,accounting for 5.8%(88/1517)of the renal cancer patients admitted in the same period.According to the statistical analysis,the median age was 57 years old(22-77 years old),and the gender difference was 56 males and 32 females.Laparoscopic radical nephrectomy was performed in 1 case and open radical nephrectomy in 87 cases.The tumor size in the postoperative pathological analysis report was statistically analyzed,and the mean maximum diameter was 8.49cm(3cm-18cm).In the study,pathological types were included in the postoperative diagnosis of renal clear cell carcinoma.According to the statistics of the pathological grades of Fuhrman,46 patients were diagnosed as FuhrmanⅠ/Ⅱ and 29 patients were diagnosed as FuhrmanⅢ/Ⅳ,among which 13 were not recorded.Intratumoral conditions included:7 cases with sarcomatoid changes,2 cases with intratumoral necrosis,and 1 case with thrombotic necrosis of renal vein tumor.The cases of tumor with tumor thrombus were as follows:25 patients with renal vein tumor thrombus and 27 patients with inferior vena cava tumor thrombus.Other conditions included tumor invasion of perirenal fascia in 3 patients,postoperative local lymph node metastasis in 17 patients,ipsilateral adrenal invasion in 4 patients.According to TNM stages,there were 13 cases of T1-2N1M0 stage and 75 cases of T3-4N0-1M0 stage.Venous aneurysm plugs were classified into 5 grades according to Mayo grade,including 25 patients with Mayo0 grade.19 cases were at Mayo1 level.5 cases of Mayo2 grade;1 case of Mayo3 grade;Two cases were at Mayo4.After surgery,46 patients received adjuvant cytokines or adjuvant targeted drugs.In this study,76 patients were followed up except the patients lost to follow-up.The median follow-up time was 61 months(6-206 months),and the follow-up rate was about 86.4%.The median Survival time of 76 patients was 65 months,and the 3-year and 5-year Survival rates were 73.2%and 54.9%.Of the patients followed up,45 developed tumor progression such as recurrence or metastasis at different times after surgery,with progression-free survival at 24 months.COX single-factor survival analysis showed that the total survival prognosis of the patients was affected by the maximum tumor diameter,adrenal invasion,perirenal fat invasion,tumor thrombi,nuclear grading,pT staging,and first diagnosis symptoms.COX multivariate analysis suggested that the independent prognostic factors affecting the survival of locally advanced renal cancer patients were tumor maximum size,Fuhrman nuclear grading and first diagnosis symptoms(P<0.05).In addition,in the further study of the influence of tumor recurrence and progression in this experiment,COX multivariate analysis showed that the independent factors affecting the prognosis of patients without progression were tumor thrombs,nuclear grade,pT stage and initial symptoms(P<0.05).Conclusion:The incidence of locally advanced patients is relatively low,and the current treatment plan is still the first choice of surgical treatment.Different specific surgical methods are determined according to the classification of tumor thrombi.Radical nephrectomy plus removal of tumor thrombi for patients with venous tumor thrombi can effectively improve the overall survival rate of patients.Lymphadenectomy did not improve survival but could provide staging to aid in later treatment.The higher the tumor stage,the greater the probability of metastasis and recurrence,and the shorter the overall survival time.Through the establishment of prognostic analysis model,it can be known that patients with the maximum length of tumor≥7cm,tumor accompanied by venous tumor thrombus,high grade Fuhrman,high pT stage,and first accompanied by symptoms have a poor prognosis. |
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