【摘要】 [目的]探讨肾癌的临床诊断与手术治疗的方法和效果。[方法]对肾癌150例资料进行回顾性分析。以Kaplan-Meier法评估两种手术方法病人的存活率差异,用Log Rank Test和Generalized Wilcoxon Test分析预后因子对存活率的影响。[结果]诊断以B超、CT、MRI为主。AJCC临床分期:I期56.67%(85/150),Ⅱ期25.33%(38/150),Ⅲ期11.33%(17/150),Ⅳ期6.67%(10/150)。Ⅰ组行肾癌根治性切除术54.67%(82/150),Ⅱ组行肾癌根治性切除加淋巴结清扫45.33%(68/150)。5年累积生存率:Ⅰ组为(77.52±3.46)%,Ⅱ组为(75.65±3.82)%;对数秩检验(Log Rank Test),两组累积生存率差异无统计学意义(χ2=1.325,P=0.265),(riskratio1.86,95%CI0.71~4.53,P=0.254)。两组5年累积生存率为75.86%±2.78%,其中pT1(97.55±1.36)%,pT2～pT4(62.51±2.37)%,pT1与pT2~4比较pT1有更高的5年生存率(Odds ratio0.264,95%CI0.075~0.972,P=0.038)。肿瘤直径小于7cm对生存率的影响有显著性(risk ratio0.38,95%CI0.16~0.82,P=0.015)。[结论]早期发现并早期根治性肾切除手术是肾癌的主要治疗方法,淋巴结清扫不能明显提高患者生存率。更多还原

【Abstract】 [Objective]To study the long-time outcome of radical nephrectomy of renal cell carcinoma.[Methods]150 cases of renal cell carcinoma treated from Jan.1993 to Jan.2010 were reviewed. Cancer specific,distant metastases-free and recurrence-free survivals were estimated by using the Kaplan-Meier method.[Results]The diagnostic means were mainly ultrasonography and CT scanning and MRI. Radical nephrectomy was done for cases of 54.67%(82/150)and cases of 45.33%(68/150)were treated by radical nephrectomy with retroperitoneal lymphadenectomy. The pathological results showed that cases of 69.33%(104/150)were clear cell carcinoma,9.33%(14/150)being granular cell carcinoma,cases of 15.33%(23/150)being combination of the above two varieties,and 9 being renal cells of other types. The patients of 90.67%(136/150)have been successfully followed up lasted until Jan 31,2010. The 5 year survival rates were 75.86%±2.78%. There were no statistically significant differences in cancer specific 5 year survival and distant metastases-free survival between patients treated Radical nephrectomy(77.52%±3.46%)and radical nephrectomy with retroperitoneal lymphadenectomy(75.65%±3.82%)after adjusting for important pathological features(Log Rank Test,χ2 = 1.325,P = 0.265),(risk ratio 1.86,95% CI 0.71-4.53,P = 0.254). Data were collected regarding on stage,sex,age,tumor size,TNM stage,therapy and survival. Multivariate analysis of TNM Stage Ⅳ variable differences indicated that only tumor size differences and nephrectomy significantly affected survival. There was a significant difference in disease specific survival in the tumor size of 7 cm(risk ratio 0.38,95% CI 0.16-0.82,P = 0.015).[Conclusion]Early diagnosis and prompt radical nephrectomy were the critical points for patients with renal cell carcinoma. Radical nephrectomy remains the cardinal methods for the treatment of primary renal cell carcinoma. Retroperitoneal lymphadenectomy does not improve the survival.更多还原