| Objective:1.To retrospectively analyze the clinicopathological features,surgical status,and trends of renal cell carcinoma patients in the past 10 years.2.To analysis the prognostic factors in patients with renal cell carcinoma.Methods:1.The electronic medical records of 1498 patients with renal cell carcinoma treated surgically in Xijing Hospital from January 2008 to December 2017 were consulted to collect clinical data.The patients were followed up by telephone inquiries.2.To set up a database of renal cell carcinoma patients in Xijing Hospital by inputting clinical data and follow-up information of 1498 cases of renal cell carcinoma into Excel table.3.To introduce the Excel data assignment into SPSS21.0,to describe and analyze the demographic characteristics,clinicopathological features,surgical conditions and changing trends of renal cell carcinoma patients,and to analyze the correlation or the difference of composition ratio among the various factors.Kaplan-Meier method and COX regression risk proportional model were used to analyze the survival status and the factors affecting the prognosis of the patients.Results:1.Of the 1498 patients with renal cell carcinoma,1017 were male and 481 were female,the mean age was 55.9 ±11.73 years,1013 urban patients and 485 rural patients,1278 clear cell carcinoma,84 papillary cell carcinoma,and 136 rare type renal cell carcinoma.Pathological examination revealed necrosis in 117 cases,sarcomatosis in 36 cases.Preoperative metastasis in 83 cases and venous tumor thrombus in 47 cases.Clinical staging: 1257 cases of stage I,1257 cases of stage II and above.Radical nephrectomy in962 cases and partial nephrectomy in 536 cases.2.The 1-year,3-,5-and 10-year survival rates of whole patients were 97.7%,90.6%,86.0%,83.1%,respectively.There were significant differences in survival rate among patients with different age groups,clinical symptoms,clinical stages,pathological types,surgical methods,surgical approaches and intraoperative bleeding volume(P <0.05).The 5-year survival rate in patients with age ? 60 years was higher than that in patients with age?60 years old.The 5-year survival rate of asymptomatic patients was higher than that of symptomatic patients,and the 5-year survival rate of T1 stage patients was higher than that of T2 stage upper patients.The 5-year survival rate of stage I,II,III and IV patients decreased sequentially.The 5-year survival rate of partial nephrectomy was higher than that of radical resection.The 5-year survival rate of patients undergoing nephrectomy through open approach,laparoscopic approach and robot-assisted laparoscopic approach increased sequentially.The 5-year survival rate of the patients with bleeding < 200 ml,200ml~400ml,> 400 ml decreased sequentially.3.The median survival time of patients with sarcomatoid renal cell carcinoma was 14 months,and the 1-year survival rate was 63.0%,the 2-year survival rate was 54.3%,the3-year survival rate was 14.3%,and the 5-year survival rate was 13.3%,the survival rate was significantly different in patients with non-sarcomatoid renal cell carcinoma(P<0.001).4.Univariate analysis showed that age,symptom,TNM stage,clinical stage,venous tumor thrombus,pathological type,pathological grade,necrosis and sarcomatosis,surgical method,surgical approach,intraoperative bleeding volume,Neutrophil / lymphocyte ratio,hemoglobin and serum albumin were the prognostic factors of renal cell carcinoma.5.Multivariate analysis showed that pathological type,age,symptom,T stage,clinical stage,distant metastasis,necrosis and sarcoidosis were independent factors affecting the prognosis of patients with renal cell carcinoma.sarcomatosis is the most influential prognostic factor,and the risk of death in patients with sarcomatoid renal cell carcinoma is4.187 times higher than that in patients with non-sarcomatous change.Conclusions :1.The proportion of renal cell carcinoma patients in urban and rural areas was higher than that in rural areas.Clear cell carcinoma was the main pathological type.The percentage of clear cell carcinoma in male patients was higher than that in female patients.The percentage of clear cell carcinoma in patients with history of hypertension was higher than that in patients without history of hypertension.Fuhrman's grade was mainly grade 2.Men may have higher pathological grades than women.Older patients may have higher pathological grades than younger patients.Pathological examination showed that the patients with necrosis may have higher pathological grade than those without necrosis.2.In the past 10 years,the age,sex,pathological type,and pathological grade of renal cell carcinoma patients have not changed significantly.The proportion of asymptomatic patients has increased year by year.The proportion of partial nephrectomy,and invasive surgery include laparoscopy and robot-assisted laparoscopic surgery has increased year by year.3.Partial nephrectomy can better protect renal function.Laparoscopic surgery,robotassisted laparoscopic surgery has the minimally invasive advantage of less bleeding and shorter hospital stay compared to open surgery.Compared with laparoscopic surgery,therewas no significant difference in intraoperative bleeding,hospitalization days and postoperative creatine between robot-assisted laparoscopic surgery and laparoscopic surgery,but the operation time was longer than that of laparoscopic surgery,and the time of renal artery occlusion was shorter than that of laparoscopic surgery.4.The overall prognosis of patients with renal cell carcinoma is better.But the patients with age more than 60 years old,with clinical symptoms,stage above T2,clinical stage above stage II,distant metastasis,necrosis and sarcomatosis had poor prognosis.The prognosis of the patients with sarcomatous renal cell carcinoma is the worst. |
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