【摘要】 目的探讨术前外周血血小板计数对肾透明细胞癌(CCRCC)预后的意义。方法回顾性分析初诊并术后病理证实的292例CCRCC患者的临床资料及随访情况,以患者血小板计数300×109/L为界值将患者分为正常和增高两组,应用Kaplan-Meier法进行生存分析并行Log-rank检验,Cox比例风险模型分析血小板增高及其他临床因素对患者总生存(OS)和无进展生存(PFS)预后的影响。结果该研究CCRCC患者中血小板增高发生率为9.59%(28/292),正常组1年、3年、5年的总生存率和无进展生存率分别为100%、99%、97%和99%、97%、86%,而增高组分别为89%、84%、84%和86%、81%、81%,两组OS(χ2=13.023,P=0.000)和PFS(χ2=3.968,P=0.046)比较有统计学意义。单因素分析显示,发病方式、肿瘤大小、肿瘤坏死情况、病理分级、T分期、TNM分期是OS的预后因素,而且肿瘤大小和TNM分期还是PFS的预后因素。多因素分析显示,病理T分期和TNM分期是PFS预后的独立因素,血小板计数是OS预后的独立因素。结论术前外周血血小板增高是CCRCC预后不良的独立预后因素。更多还原

【Abstract】 Objective To evaluate the prognostic significance of the preoperative elevated platelet count in patients with clear cell renal cell carcinoma(CCRCC). Methods The clinical data of 292 CCRCC patients, firstly diagnosed and confirmed by postoperative tissue diagnosis, was analyzed retrospectively and all of them were followed-up. The 292 patients were divided into normal and elevated groups by the value of platelet count(300×109/L). Kaplan-Meier and Log-Rank test were used to analyze the data. Prognostic factors of over survival(OS)and progression free survival(PFS) in these patients were analyzed by Cox proportional hazards model. Results 1 year, 3 years, 5 years overall survival rates and progression free survival rates were 100%, 99%, 97% and 99%, 97%, 86% in normal group and 89%, 84%, 84% and 86%, 81%, 81% in elevated group, respectively. OS(χ2=13.023, P=0.000) and PFS(χ2=3.968, P=0.046) between two group were statistically different.Univariate analysis showed that patients diagnosed with or without kidney triad, tumor size, tumor necrosis, pathological grade, T stage, TNM stage were prognostic factors of the OS in CCRCC patients and tumor size and TNM stage were also prognostic indicator of the PFS. Multivariate analysis showed that T stage and TNM stage were independent prognostic factors of the PFS for CCRCC and preoperative platelet count was an independent prognostic predictor of the OS. Conclusion The preoperative thrombocytosis is an independent poor prognostic factor for CCRCC.更多还原