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北京大学学报（医学版） ›› 2022, Vol. 54 ›› Issue (4): 615-620. doi: 10.19723/j.issn.1671-167X.2022.04.006

• 论著 • 上一篇    下一篇

乳头状肾细胞癌的临床病理特征和预后分析

博尔术1,洪鹏1,张宇1,邓绍晖1,葛力源1,陆敏2,李楠3,马潞林1,张树栋1,*()   

  1. 1. 北京大学第三医院泌尿外科，北京 100191
    2. 北京大学第三医院病理科，北京 100191
    3. 北京大学第三医院临床流行病学研究中心，北京 100191
  • 收稿日期:2022-04-06 出版日期:2022-08-18 发布日期:2022-08-11
  • 通讯作者: 张树栋 E-mail:zhangshudong@bjmu.edu.cn
  • 基金资助:
    国家自然科学基金(82072828);北京大学第三医院临床重点项目(BYSYZD2019016);北京大学第三医院海淀创新转化专项科创研发(HDCXZHKC2021208)

Clinicopathological features and prognostic analysis of papillary renal cell carcinoma

Er-shu BO1,Peng HONG1,Yu ZHANG1,Shao-hui DENG1,Li-yuan GE1,Min LU2,Nan LI3,Lu-lin MA1,Shu-dong ZHANG1,*()   

  1. 1. Department of Urology, Peking University Third Hospital, Beijing 100191, China
    2. Department of Pathology, Peking University Third Hospital, Beijing 100191, China
    3. Research Centre of Clinical Epidemiology, Peking University Third Hospital, Beijing 100191, China
  • Received:2022-04-06 Online:2022-08-18 Published:2022-08-11
  • Contact: Shu-dong ZHANG E-mail:zhangshudong@bjmu.edu.cn
  • Supported by:
    the National Natural Science Foundation of China(82072828);Key Clinical Projects of Peking University Third Hospital(BYSYZD2019016);Innovative Transformation Projects of Haidian District(HDCXZHKC2021208)

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摘要：

目的: 探讨乳头状肾细胞癌(papillary renal cell carcinoma，pRCC)的临床病理特征和预后特点。方法: 回顾性分析2012年5月至2021年5月北京大学第三医院泌尿外科收治的114例pRCC患者的临床资料，包括91例男性和23例女性。所有病例均为手术患者，病理诊断明确，随访数据完整。采用Kaplan-Meier法绘制生存曲线并通过log-rank检验分析患者临床病理特征与生存时间的关系，使用Cox比例风险回归模型分析影响患者无进展生存率的因素。结果: 114例患者平均年龄(57.3±12.6)岁。肿瘤位于左肾49例，右肾65例。48例行根治性肾切除术，66例行肾部分切除术。1型pRCC 42例，2型72例，肿瘤平均最大径为(5.5±3.6) cm。肿瘤分期pT1a期52例，pT1b期22例，pT2期4例，pT3期33例，pT4期3例。2016年世界卫生组织/国际泌尿病理学会(World Health Organization / International Society of Urological Pathology，WHO/ISUP)分级Ⅰ级13例，Ⅱ级44例，Ⅲ级51例，Ⅳ级6例。114例患者中34例伴有脉管癌栓，30例伴淋巴结转移，3例伴肾上腺转移。患者术后中位随访时间为22个月，3年无进展生存率为95.6%。1型和2型pRCC患者在年龄(P=0.046)、体重指数(P=0.008)、手术方式(P=0.001)、肿瘤最大径(P < 0.001)、脉管癌栓(P < 0.001)、淋巴结转移(P < 0.001)、pT分期(P < 0.001)和核分级(P < 0.001)方面差异均有统计学意义。1型和2型pRCC的3年无进展生存率分别为100%和69.4%，1型预后明显优于2型(P=0.003)。2型pRCC患者的单因素分析结果显示，pT分期(P < 0.001)、脉管癌栓(P < 0.001)和淋巴结转移(P < 0.001)与其预后紧密相关；多因素分析显示，脉管癌栓为2型pRCC无进展生存率的独立预后因素(P=0.001)。行根治性肾切除术的pRCC患者的单因素分析结果显示，pT分期(P=0.006)、脉管癌栓(P=0.001)和淋巴结转移(P=0.008)是影响其预后的显著因素，进一步多因素分析显示只有脉管癌栓是其无进展生存率的独立预后因素(P=0.006)。结论: 2型pRCC比1型pRCC发病率更高，淋巴结转移更易出现，pT分期更晚，核分级更高。在2型pRCC和根治性切除术后的pRCC患者中，脉管癌栓是其独立预后因素。

关键词: 乳头状肾细胞癌, 临床特征, 临床病理学, 预后

Abstract:

Objective: To investigate the clinicopathological features and prognostic characteristics of papillary renal cell carcinoma (pRCC). Methods: The clinical data of 114 patients with pRCC, including 91 males and 23 females, admitted to the Department of Urology, Peking University Third Hospital from May 2012 to May 2021 were retrospectively analyzed. All the cases were operated patients with clear pathological diagnosis and complete follow-up data. The log-rank test was used to analyze the relationship between the patients' clinicopathological characteristics and survival time, the Kaplan-Meier method to draw survival curves, and the Cox regression model for univariate and multifactorial analysis. Results: The mean age of the 114 patients was (57.3±12.6) years. The tumors were located in the left kidney in 49 cases and in the right kidney in 65 cases. In the study, 48 radical nephrectomies and 66 partial nephrectomies were performed, 42 cases were type 1 and 72 cases were type 2, and the mean maximum tumor diameter was (5.5±3.6) cm. pT1a stage 52 cases, pT1b stage 22 cases, pT2 stage 4 cases, pT3 stage 33 cases, and pT4 stage 3 cases were staged. According to the World Health Organization / International Society of Urological Pathology (WHO/ISUP), there were 13 cases of gradeⅠ, 44 cases of grade Ⅱ, 51 cases of grade Ⅲ, and 6 cases of grade Ⅳ. And 34 of the 114 patients had vascular cancer embolism, 30 cases had lymph node metastasis, and 3 cases had adrenal metastasis. The median follow-up time after surgery was 22 months, and the 3-year progression-free survival rate was 95.6%. The patients with type 1 and type 2 pRCC showed statistically significant differences in age (P=0.046), body mass index (P=0.008), surgical approach (P=0.001), maximum tumor diameter (P < 0.001), vascular cancer embolism (P < 0.001), lymph node metastasis (P < 0.001), pT stage (P < 0.001), and nuclear grade (P < 0.001). The 3-year progression-free survival rates for type 1 and type 2 pRCC were 100% and 69.4%, respectively, with type 1 having a significantly better prognosis than with type 2 (P=0.003). Univariate analysis of the patients with type 2 pRCC showed that pT stage (P < 0.001), vascular cancer embolism (P < 0.001) and lymph node metastasis (P < 0.001) were strongly associated with their prognosis. Multifactorial analysis showed that vascular cancer embolism was an independent prognostic factor for progression-free survival in type 2 pRCC (P=0.001). Univariate analysis of the pRCC patients undergoing radical nephrectomy showed that pT stage (P=0.006), vascular cancer embolism (P=0.001), and lymph node metastasis (P=0.008) were significant factors affecting their prognosis, and further multifactorial analysis showed that only vascular cancer embolism was an indepen-dent prognostic factor for their progression-free survival (P=0.006). Conclusion: Type 2 pRCC has more morbidity, more lymph node metastases, more advanced pT stage, and higher pathologic grading than type 1 pRCC. The presence of vascular cancer embolism is an independent prognostic factor in patients with type 2 pRCC and pRCC undergoing radical nephrectomy.

Key words: Papillary renal cell carcinoma, Clinical features, Clinical pathology, Prognosis

中图分类号: 

  • R737.11

表1

114例pRCC患者的基本临床病理特征"

Items Value
Gender, n(%)
  Male 91 (79.8)
  Female 23 (20.2)
Age/years, $\bar x \pm s$ 57.3±12.6
BMI/(kg/m2), $\bar x \pm s$ 25.1±3.1
Tumor location, n(%)
  Left 49 (43.0)
  Right 65 (57.0)
Surgical method, n(%)
  Partial nephrectomy 66 (57.9)
  Radical nephrectomy 48 (42.1)
Maximum tumor diameter/cm, $\bar x \pm s$ 5.5±3.6
pT stages, n(%)
  T1a 52 (45.6)
  T1b 22 (19.3)
  T2 4 (3.5)
  T3 33 (28.9)
  T4 3 (2.6)
Nuclear grade, n(%)
  Ⅰ 13 (11.4)
  Ⅱ 44 (38.6)
  Ⅲ 51 (44.7)
  Ⅳ 6 (5.3)
Vascular cancer embolism, n(%)
  Yes 34 (29.8)
  No 80 (70.2)
Adrenal metastasis, n(%)
  Yes 3 (2.6)
  No 111 (97.4)
Lymph node metastasis, n(%)
  Yes 30 (26.3)
  No 84 (73.7)
Symptoms, n(%)
  Osphyalgia 17 (14.9)
  Hematuria 19 (16.7)
  Physical examination found 78 (68.4)

表2

1型和2型pRCC患者的临床病理特征比较"

Items Type 1 Type 2 P
Gender, n 0.231
  Male 36 55
  Female 6 17
Age/years, $\bar x \pm s$ 54.1±11.5 59.0±12.9 0.046
BMI/(kg/m2), $\bar x \pm s$ 26.1±2.9 24.5±3.1 0.008
Tumor location, n 0.421
  Left 16 33
  Right 26 39
Surgical method, n 0.001
  Partial nephrectomy 33 33
  Radical nephrectomy 9 39
Maximum tumor
diameter/cm, $\bar x \pm s$		 3.55±2.30 6.63±3.69 < 0.001
Vascular cancer embolism, n < 0.001
  Yes 1 33
  No 41 39
Lymph node metastasis, n < 0.001
  Yes 0 30
  No 42 42
Adrenal metastasis, n 0.463
  Yes 0 3
  No 42 69
pT stages, n < 0.001
  T1a 28 24
  T1b 10 12
  T2 2 2
  T3 1 32
  T4 1 2
Nuclear grade, n < 0.001
  Ⅰ 13 0
  Ⅱ 24 20
  Ⅲ 5 46
  Ⅳ 0 6
Symptoms, n 0.002
  Osphyalgia 3 14
  Hematuria 2 17
  Physical examination found 37 41

图1

1型和2型pRCC患者术后无进展生存曲线"

表3

2型pRCC患者预后相关的单因素和多因素分析"

Items Univariate analysis Multifactorial analysis
(P)
HR 95%CI P
Gender (Male/Female) 0.296 0.038-2.295 0.215
BMI (>24.9 kg/m2/≤24.9 kg/m2) 0.913 0.290-2.871 0.876
Tumor location (Left/Right) 0.799 0.256-2.498 0.700
Surgical method (Radical/Partial) 3.316 0.886-12.417 0.055 0.100
pT stages (T3-4/ T1-2) 12.495 2.605-59.929 < 0.001 0.584
Nuclear grade (Ⅲ-Ⅳ / Ⅰ-Ⅱ) 1.333 0.391-4.541 0.641
Vascular cancer embolism (Yes/No) 34.301 3.983-295.376 < 0.001 0.001
Lymph node metastasis (Yes/No) 15.257 2.767-84.121 < 0.001 0.558
Adrenal metastasis (Yes/No) 4.009 0.488-32.905 0.274

图2

有无脉管癌栓的2型pRCC患者无进展生存曲线"

图3

肾部分切除术和根治性肾切除术的pRCC患者无进展生存曲线"

表4

根治性肾切除术后pRCC患者预后的单因素和多因素分析"

Items Univariate analysis Multifactorial analysis
(P)
HR 95%CI P
BMI (>24.9/≤24.9 kg/m2) 0.655 0.173-2.477 0.537
Tumor location (Left/Right) 0.984 0.258-3.759 0.982
Nuclear grade (Ⅲ-Ⅳ / Ⅰ-Ⅱ) 2.300 0.494-10.722 0.275
pT stages (T3-4/ T1-2) 7.412 1.503-36.540 0.006 0.452
Vascular cancer embolism (Yes/No) 21.445 2.455-187.305 0.001 0.006
Lymph node metastasis (Yes/No) 10.386 1.241-86.938 0.008 0.499
Adrenal metastasis (Yes/No) 3.380 0.392-29.172 0.334
pRCC (Type 1 / Type 2) 0.863 0.331-2.674 0.132 0.493

表5

高pT分期pRCC患者预后的单因素分析"

Items HR 95%CI P
Gender (male/female) 0.281 0.035-2.270 0.163
BMI (>24.9 / ≤24.9 kg/m2) 1.379 0.385-4.944 0.626
Tumor location (Left/Right) 1.359 0.361-5.113 0.649
Surgical method (Radical/Partial) 1.815 0.465-7.079 0.375
Nuclear grade (Ⅲ-Ⅳ / Ⅰ-Ⅱ) 1.009 0.242-4.205 0.990
Vascular cancer embolism (Yes/No) 35.011 0.015-82 945.630 0.058
Lymph node metastasis (Yes/No) 1.994 0.395-10.068 0.376
Adrenal metastasis (Yes/No) 1.931 0.230-16.217 0.575
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CN 11-4691/R
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