淋巴结肿大的肾细胞癌患者发生淋巴结转移的影响因素
摘要
目的分析淋巴结肿大的肾细胞癌(RCC)患者发生淋巴结转移的影响因素。方法选取郑州市第一人民医院2013年1月20日至2017年7月30日收治的210例术前腹部CT或术中探查提示腹膜后淋巴结肿大的RCC患者作为研究对象。患者均接受肾根治性切除术加腹膜后淋巴结清扫或区域淋巴结清扫术,根据术后病理学检查结果,将患者分为淋巴结阴性组(165例)和淋巴结阳性组(45例)。收集并比较淋巴结阴性组和淋巴结阳性组患者临床资料,采用Logistic回归分析腹膜后淋巴结转移的独立危险因素。结果两组患者年龄、临床症状(腰痛、血尿)、T分期、Furhman核分级、肿瘤直径、肿瘤组织内肉瘤样结构,以及肾被膜受侵情况相比,差异有统计学意义(均P<0.05)。多因素分析结果显示,年龄≤45岁、伴血尿、T分期为T_(3～4)、Furhman核分级为3～4级、肿瘤直径≥4 cm、肿瘤组织内存在肉瘤样结构,以及肾被膜受侵是腹膜后淋巴结转移的独立危险因素(均P<0.05)。结论年龄较小、伴血尿、T分期为T_(3～4)、Furhman核分级为3～4级、肿瘤直径较大、肿瘤组织内存在肉瘤样结构,以及肾被膜受侵是淋巴结肿大的RCC患者腹膜后淋巴结转移的独立危险因素。
引文
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[12] CAPITANIO U, BECKER F, BLUTE M L, et al. Lymph node dissection in renal cell carcinoma[J]. Eur Urol, 2011, 60(6): 1212-1220.
[2] CALVO E, SCHMIDINGER M, HENG D Y, et al. Improvement in survival end points of patients with metastatic renal cell carcinoma through sequential targeted therapy[J]. Cancer Treat Rev, 2016, 50: 109-117.
[3] SISKA P J, BECKERMANN K E, RATHMELL W K, et al. Strategies to overcome therapeutic resistance in renal cell carcinoma[J]. Urol Oncol, 2017, 35(3): 102-110.
[4] CAPITANIO U, BECKER F, BLUTE M L, et al. Lymph node dissection in renal cell carcinoma[J]. Eur Urol, 2011, 60(6): 1212-1220.
[5] CAPITANIO U, LEIBOVICH B C. The rationale and the role of lymph node dissection in renal cell carcinoma[J]. World J Urol, 2017, 35(4): 497-506.
[6] GUO J, MA J, SUN Y, et al. Chinese guidelines on the management of renal cell carcinoma (2015 edition)[J]. Ann Transl Med, 2015, 3(19): 279.
[7] SIEGEL R L, MILLER K D, JEMAL A. Cancer Statistics, 2017[J]. CA Cancer J Clin, 2017, 67(1): 7-30.
[8] SHINDER B M, RHEE K, FARRELL D, et al. Surgical management of advanced and metastatic renal cell carcinoma: a multidisciplinary approach[J]. Front Oncol, 2017, 7: 107.
[9] LEE H W, JEON H G, JEONG B C, et al. Diagnostic and prognostic significance of radiologic node-positive renal cell carcinoma in the absence of distant metastases: a retrospective analysis of patients undergoing nephrectomy and lymph node dissection[J]. J Korean Med Sci, 2015, 30(9): 1321-1327.
[10] 王雷, 杜青山, 张帆, 等. 肾癌伴淋巴结肿大患者淋巴结阳性的危险因素分析[J]. 微创泌尿外科杂志, 2016, 5(3): 179-182.
[11] BABAIAN K N, KIM D Y, KENNEY P A, et al. Preoperative predictors of pathological lymph node metastasis in patients with renal cell carcinoma undergoing retroperitoneal lymph node dissection[J]. J Urol, 2015, 193(4): 1101-1107.
[12] CAPITANIO U, BECKER F, BLUTE M L, et al. Lymph node dissection in renal cell carcinoma[J]. Eur Urol, 2011, 60(6): 1212-1220.