基础医学与临床 ›› 2021, Vol. 41 ›› Issue (3): 409-414.

• 研究论文 • 上一篇    下一篇

肾透明细胞癌行保留肾单位手术后复发风险预测模型的构建

陈志刚,洪鹏,杨斌,田晓军,王国良,张树栋,马潞林   

  1. 北京大学第三医院
  • 收稿日期:2020-11-06 修回日期:2020-12-24 出版日期:2021-03-05 发布日期:2021-03-01
  • 通讯作者: 马潞林 E-mail:malulinpku@163.com

Constructing a risk predictive model for recurrence following nephron-sparing surgery in the treatment of clear cell renal cell carcinoma

  • Received:2020-11-06 Revised:2020-12-24 Online:2021-03-05 Published:2021-03-01

摘要: 目的 探讨临床局限性肾透明细胞癌(ccRCC)患者行肾部分切除术(NSS)后复发的相关危险因素,建立NSS术后5年复发风险的预测模型。方法 回顾性分析2006年1月至2019年7月于北京大学第三医院行NSS患者的临床资料,采用单因素和多因素回归分析影响ccRCC术后复发的相关因素,并建立预测NSS术后5年复发风险的列线图。结果 共计795例经病理诊断为ccRCC的患者纳入研究。随访过程中,17例发生复发,复发率为2.1%,中位复发时间为35.7个月。在单因素回归分析中,BMI(HR=4.102,P <0.05)、动脉阻断时间(HR=0.194,P <0.01)和肿瘤坏死或肉瘤样改变(HR=5.160,P <0.01)与术后无复发生存相关。多因素回归分析显示这3个因素是无复发生存的独立影响因素。采用内部验证法对复发风险列线图的准确性进行验证,C指数为0.843。结论 BMI、动脉阻断时间、肿瘤坏死或肉瘤样改变是影响ccRCC术后复发的独立因素。本研究建立了一个相对准确的预测复发风险的模型,这将有助于为ccRCC患者提供个性化的治疗。

关键词: 肾透明细胞癌, 肾部分切除术, 复发, 预后, 列线图

Abstract: Objective To detect factors associated with recurrence after nephron sparing surgery (NSS) in patients with clinically localized clear cell renal cell carcinoma (ccRCC), and construct a model to predict the recurrence risk in five years following NSS. Methods Data of the patients who underwent NSS for renal occupied lesions between January 2006 and July 2019 at Peking University Third Hospital were retrospectively analyzed. Univariate and multivariate logistic regression analyses were used to assess the factors associated with recurrence of ccRCC after NSS, and a nomogram was established to predict recurrence risk in 5 years following NSS. Results 795 patients who were pathologically diagnosed with ccRCC were included in the study. Recurrence occurred in 17 cases, with the recurrence rate 2.1%. The median time to relapse was 35.7 months. In the univariable analysis, BMI (HR = 4.102, P < 0.05), the artery blocking time (HR = 0.194, P < 0.01) and tumor necrosis or sarcomatoid change (HR = 5.160, P < 0.01) were associated with recurrence-free survival of the ccRCC patients after NSS. The multivariate analysis showed that these three factors were independent factors of recurrence. The accuracy of our nomogram for recurrence risk was verified using internal validation, and the value of c-index was 0.843. Conclusions BMI, artery blocking time and tumor necrosis or sarcomatoid change were independent factors for recurrence following NSS in the ccRCC patients. We constructed an accurate model to predict the recurrence risk, which may help to provide personalized managements for the aforementioned patients after NSS.

Key words: clear cell renal cell carcinoma, partial nephrectomy, recurrence, prognosis, nomogram

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