| Objectives:103 cases of renal clear cell carcinoma were analyzed with the 2016 new WHO/ISUP classification.The proportion of tumor cells and necrosis at each level was marked,and the results were compared with the prognosis of the patients.The most advanced tumor cell pairs were studied.The prognosis has an impact on the cut-off value and explores the main factors affecting prognosis,providing a reference value for improving the 2016 new WHO/ISUP classification to better guide clinical treatment.Methods:To between 2010 and 2018 in the second affiliated hospital of kunming medical university to have surgery,and preoperative without any auxiliary treatment,postoperative pathology,the first by the diagnosis of renal clear cell carcinoma patients as the research object,collects the pathological and clinical data of 103 cases of patients,according to the 2016 version of the WHO/ISUP classification system,on the set of all cases of tumor pathological section contains all levels of the proportion of tumor cell necrosis and existing comprehensive interpretation,and follow-up of patients with transferring follow-up results are divided into groups and transfer.SPSS22.0 software was used for statistical analysis,and chi-square test was used to analyze the correlation between gender,age,tumor size,surgical method,presence of tumor thrombi,necrosis and prognosis of patients.KM curve was established with the statistical software x-tile to analyze the cut-off point value of the influence of the proportion of different grades of tumor cells on the prognosis.Cox regression was used to analyze the difference of pathological grading between groups.Logistic regression was used for multivariate analysis of prognostic factors.P<0.05 was considered statistically significant.Results:1.A total of 103 patients with renal clear cell carcinoma were collected,including 72 male patients,accounting for 69.9%,and 31 female patients,accounting for 30.1%.The ratio of male to female is 2.32:1;the age range of patients is 24 to 82 years old,with an average age of 53.8±13.0 years;52 cases are from 40 to 60 years old,accounting for 50.5%,and 17 cases are under 40 years old,accounting for 16.5%,greater than There are 34 cases at the age of 60,accounting for 33.0%.There were 51 cases of tumors located in the right kidney,accounting for 49.5%,52 cases of tumors located in the left kidney,accounting for 50.5%,and the incidence of left and right kidney lesions was 1.01:1.The maximum diameter of the tumor is 1.5 cm to 13 cm,and the average maximum diameter is 4.4 cm±2.0 cm.2.According to AJCC’s ATM staging,renal clear cell carcinoma pathological classification criteria,89 cases of pT1 stage,accounting for 86.4%,of which 51 cases were pTla cases,accounting for 49.5%,38 cases of pTlb cases,accounting for 36.9%;5 cases of pT2 cases,accounting for 4.9%,including 4 cases of pT2a cases,accounting for 3.9%,1 case of pT2b cases,accounting for 0.97%;8 cases of pT3 cases,accounting for 7.8%,of which pT3a period There were 1 case,accounting for 0.97%,7 cases in pT3b stage,accounting for 6.8%,and 1 case in pT4 stage,accounting for 0.97%.3.Among the 103 cases enrolled,77 cases underwent total renal operation,accounting for 74.8%.26 cases underwent partial nephrectomy,accounting for 25.2%.4.103 cases were enrolled,the longest follow-up time was 78 months,the shortest follow-up time was 5 months,and the average follow-up time was 26.33± 15.97 months.During the follow-up period,9 patients had metastases,accounting for 8.7%,of which 4 were lung metastases,2 were contralateral renal metastases,2 were multiple metastases,and 1 was bone metastases.The longest follow-up time for metastases was 44 months,the shortest follow-up time was 5 months.5.According to the 2016 new WHO/ISUP classification,among the 103 cases,16 were in the first level,accounting for 15.5%,57 in the second level,accounting for 55.3%,28 in the third,accounting for 27.2%,and 2 in the fourth.Accounted for 2.0%.There were 26 cases with necrosis,accounting for 25.2%of the total number of cases,including 1 case of 1 grade,accounting for 0.97%of the total number of cases,accounting for 3.8%of the number of necrotic cases;10 cases of grade 2,accounting for 9.7%of the total number of cases,accounting for 38.5%of the number of necrotic cases;13 cases of grade 3,accounting for 12.6%of the total number of cases,accounting for 50%of the number of necrotic cases;all cases of stage 4 contain necrosis,a total of 2 cases,accounting for 2.0%of the total number of cases,Accounted for 7.7%of the number of necrotic cases.There were 9 cases of metastasis,accounting for 8.4%of the total number of cases.Among them,1 case was grade 2,accounting for 0.94%of the total number of cases;7 cases were grade 3,accounting for 6.8%of the total cases;1 case was grade 4,accounting for 0.97%of the total cases.There were 96 cases of intravascular thrombosis,accounting for 93.2%,and 7 cases of intravascular tumor thrombus,accounting for 6.8%,the ratio of the two was 13.3:1.6.In 103 cases,the percentage of tumor cells at all levels was evaluated.The results showed that among the 16 cases with grade 1 of pathological grade,the average ratio of grade 1 cells was 99.8±0.75%.One case was associated with necrosis,and the proportion of necrosis was 3%.Among the 57 cases with pathological grade 2,the average value of the first-order cells was 51.6±29.1%,and the average of the second-order cells was 46.4±29.4%.Among them,10 cases contained necrosis,accounting for the average,the value is 5±19.7%.Among the 28 cases with pathological grade 3,the average value of grade 1 cells was 26.0±21.1%,the average value of grade 2 cells was 52.8±19.7%,and the average value of grade 3 cells was 13.6±.11.3%,of which 13 cases contained necrosis,with an average of 16.3±7.09%.In the pathological grade 4 cases,the average value of the first-order cells was 7.5±10.6%,the average value of the second-order cells was 30± 14.1%,and the average value of the third-order cells was 35±7.1%.The average value of the fourth-order cells was 7.5±3.5%,and all cases contained necrosis,and the average value was 20±14.1%.7.Statistical results:Statistical software spss22.0,using chi-square test results showed that there was no significant difference in the prognosis between male patients and female patients(P=0.054);tumors in the left kidney or right kidney had no significant difference in prognosis(P=0.737);the effect of age on prognosis was not statistically significant(P=0.152);tumor size had a statistically significant effect on prognosis(P=0.001);there was a statistically significant difference in prognosis between different pT stages(P=0.000).There was no significant difference in the prognosis between the surgical methods(P=0.107);the effect of the tumor thrombus on the prognosis was not statistically significant(P=0.054);when the case was accompanied by necrosis,the impact on the prognosis was statistically different.(P=0.001).Logistic regression analysis showed that the correlation between pT stage,tumor size,necrosis and tumor prognosis was analyzed by multivariate analysis.The pT stage(P=0.004)and necrosis(P=0.044)had statistical significance on the prognosis.Tumor size there was no statistically significant effect on prognosis(P=0,19).Cox regression analysis showed that the effect of WHO/ISUP graded pathological grade on the prognosis was statistically significant(P=0.017),but the survival curve between different pathological grades was not statistically significant(P>0.05);After the point value was re-graded,the pathological grade had a statistically significant prognosis(P=0.002),but the survival curve between different pathological grades was not statistically significant(P>0.05).Use the statistical software X-tile to find the cut-off value;the P value of the tumor cells at the 2nd level is 35%,and the P value is 0.53,and the P value at the 3rd grade is 20%.After reclassifying with 35%as the level 2 cut-off value,there was no significant difference in the prognosis between the grade 1 and grade 2 cases(P=0.473);after using the cut-off point level 3 cells to re-classify the ratio of 20%,There was a statistically significant difference in prognosis between grades 3 and 4(P=0.027).Conclusions:Compared with women,men have a higher risk of renal clear cell carcinoma;tumor size is a risk factor affecting the prognosis of renal clear cell carcinoma;pT stage,necrosis is an independent risk factor affecting the prognosis of renal clear cell carcinoma;patient age,Gender,surgical methods,and tumor thrombus had no significant effect on the prognosis of renal clear cell carcinoma;the higher the WHO/ISUP grade of renal clear cell carcinoma,the greater the risk of patient metastasis;in the 2016 new WHO/ISUP classification,when the level 2 cells accounted for The ratio was 35%,and the proportion of grade 3 cells was 20%as the cut-off value.After regrouping,the prognosis of renal clear cell carcinoma was statistically significant.After re-grading with 20%of the 3 grades cell fraction cut-off values,grades 3 and 4 had statistically significant differences in prognosis. |
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