【摘要】 目的 探讨行手术治疗T3a期肾非透明细胞癌患者远期预后的影响因素并构建其预测模型。方法 回顾性选取2016年1月至2023年1月于阜阳市第二人民医院接受手术治疗的T3a期肾非透明细胞癌患者64例。绘制生存曲线，并比较不同临床特征亚组5年总生存率。采用Cox单因素及多因素分析筛选患者远期预后的独立影响因素，并进行预测模型构建及效能分析。结果 64例患者中位随访时间为45.0个月，死亡13例，5年无进展生存率和总生存率分别为68.31%和71.82%；肿瘤最大径、术前乳酸脱氢酶水平、术前空腹血糖水平及是否存在肾静脉侵犯且无静脉壁侵犯患者的5年总生存率比较，差异有统计学意义（P<0.05）。Cox比例风险回归结果显示，肿瘤最大径较大、术前乳酸脱氢酶水平高及存在肾静脉侵犯且无静脉壁侵犯均是行手术治疗T3a期肾非透明细胞癌远期预后独立危险因素（P<0.05）。基于上述独立影响因素构建的列线图模型，对训练集1年、3年、5年生存结局预测的曲线下面积分别为0.783、0.741、0.748；对验证集1年、3年、5年生存结局预测的曲线下面积分别为0.880、0.851、0.808。结论 行手术治疗T3a期肾非透明细胞癌患者远期预后与肿瘤大小、术前乳酸脱氢酶水平及周围组织侵犯情况有关；基于上述因素构建列线图模型在预测患者术后生存结局方面显示出良好效能。更多还原

【Abstract】 Objective To investigate the factors influencing the long-term prognosis of surgically treated stage T3a non-clear cell renal cell carcinoma and to construct a corresponding predictive model. Methods A total of 64 patients with stage T3a non-clear cell renal cell carcinoma who underwent surgical treatment at Fuyang No.2 People’s Hospital from January 2016 to January 2023 were retrospectively included. Survival curves were plotted, and the 5-year overall survival rates were compared among subgroups with different clinical characteristics. Univariate and multivariate Cox analyses were performed to identify independent factors affecting long-term prognosis, and a predictive model was constructed with its predictive performance analyzed. Results The median follow-up time of the 64 patients was 45.0 months, during which 13 patients died. The 5-year progression-free survival rate and overall survival rate were 68.31% and 71.82%, respectively. Significant differences in 5-year overall survival were observed among subgroups stratified by maximum tumor diameter, preoperative lactate dehydrogenase level, preoperative fasting blood glucose level, and the presence of renal vein invasion without venous wall invasion(P<0.05). Cox proportional hazards regression results showed that larger maximum tumor diameter, higher preoperative lactate dehydrogenase level, and the presence of renal vein invasion without venous wall invasion were independent risk factors for the long-term prognosis of surgically treated stage T3a non-clear cell renal cell carcinoma(P<0.05). The nomogram model constructed based on the above independent factors demonstrated area under the curve values of 0.783, 0.741, and 0.748 for predicting 1, 3, and 5 year survival outcomes in the training set, and 0.880, 0.851, and 0.808 for the corresponding outcomes in the validation set. Conclusion The long-term prognosis of surgically treated stage T3a non-clear cell renal cell carcinoma may be associated with tumor size, preoperative lactate dehydrogenase level, and the status of perinephric tissue invasion. The nomogram model constructed based on these factors shows good performance in predicting postoperative survival outcomes.更多还原