【摘要】 目的 验证c M0(i+)分期诊断标准在局限性肾癌(LRCC)中的临床作用。方法收集2015年5月至2021年11月西安交通大学第二附属医院泌尿外科行手术治疗的LRCC患者的数据资料作为验证集,对术后循环肿瘤细胞(CTCs)检测数据进行Kaplan-Meier分析和Log-rank检验,并进行单因素和多因素Cox回归分析,验证其与LRCC患者术后无进展生存期(PFS)的相关性。使用时间依赖的受试者工作特征(ROC)曲线对c M0(i+)分期的区分度进行评价。构建列线图对LRCC患者的预后进行预测。使用SPSS 26.0软件及R Studio软件完成以上分析,显著性水平P<0.05时,差异有统计学意义。结果 在LRCC患者中,Kaplan-Meier分析显示c M0(i+)分期患者的PFS明显短于对照组(P<0.001)。多因素Cox回归分析显示,c M0(i+)分期是LRCC术后进展的独立危险因素,其预测区分度ROC曲线下面积(AUC)为0.832(0.737～0.926)。依据c M0(i+)分期和临床病理特征建立的列线图,其AUC为0.914(0.893～0.935)。结论 c M0(i+)分期是LRCC患者术后进展的独立危险因素,能够较为准确地区分出PFS较短的人群。依据c M0(i+)分期和患者临床病理特征建立的列线图,对LRCC患者的预后具备良好的预测作用。更多还原

【Abstract】 Objective To verify the clinical value of previous established c M0(i+) staging criteria in localized renal cell carcinoma(LRCC). Methods The present study enrolled patients with LRCC who had received surgeries at the Department of Urology, the Second Affiliated Hospital of Xi’an Jiaotong University from May 2015 to November 2021 retrospectively, and defined them as the validation group. Kaplan-Meier analysis and Log-rank test were performed using postoperative circulating tumor cells(CTCs) data. Univariate and multivariate Cox regression analysis were performed to validate the correlation between CTCs and progression-free survival(PFS). Time-dependent receiver operator characteristic(ROC) curve was utilized to evaluate the discrimination of the c M0(i+) staging criteria. Prognosis of the patients enrolled was predicted using a nomogram. SPSS 26.0 software and R Studio software were used to conduct the above analyses, and p value less than 0.05 was considered to be statistically significant. Results In patients with LRCC, Kaplan-Meier analysis showed that patients with c M0(i+) stage had significantly shorter PFS than those in the control group. The results of multivariate Cox regression analysis showed that c M0(i+) stage was an independent risk factor in postoperative progression of LRCC patients, and the predictive discrimination area under the curve(AUC) was 0.832(0.737-0.926). The predictive discrimination of the nomogram established based on the c M0(i+) stage and clinicopathological features was 0.914(0.893-0.935). Conclusions The c M0(i+) stage is an independent risk factor in postoperative progression of patients with LRCC, and can accurately determine LRCC patients with short PFS. The nomogram established based on c M0(i+) stage and clinicopathological features of patients with LRCC has a favorable predictive effect on the prognosis o f these patients.更多还原