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目的探讨无远处转移肾癌伴肾静脉瘤栓患者行开腹根治性肾切除联合瘤栓取出术的预后影响因素。方法回顾性分析2000年1月~2014年9月我院113例术后病理证实为肾癌伴肾静脉瘤栓的临床资料,均为Mayo 0级瘤栓,采用Kaplan-Meier生存分析,Cox比例风险模型评价肾癌伴肾静脉瘤栓的预后。结果 106例获得随访,随访率93.8%(106/113),中位随访时间61个月(12~186个月),36例死亡,中位生存127个月(5~186个月),5年肿瘤特异性生存率(cancer-specific survival,CSS)为61.3%,10年CSS为50.4%。Cox比例风险模型结果显示副瘤综合征(β=2.457,P=0.000)、Fuhrman分级(G3/4)(β=2.617,P=0.000)和肾周脂肪受累(β=1.369,P=0.002)是肾癌伴肾静脉瘤栓患者的独立预后因素,同时伴有3项危险因素的患者中位生存仅14个月。结论术前无远处转移的肾癌伴肾静脉瘤栓患者行开腹根治性肾切除联合瘤栓取出术后预后良好,伴有副瘤综合征,高Fuhrman分级和肾周脂肪受累的患者预后差。
Objective To investigate the prognostic factors of radical nephrectomy combined with tumor embolization in patients without distant metastasis of renal cell carcinoma and renal vein thrombosis. Methods The clinical data of 113 patients with renal cell carcinoma and renal vein tumor thrombus confirmed by pathology in our hospital from January 2000 to September 2014 were retrospectively analyzed. All of them were Mayo 0 tumor suppository. Kaplan-Meier survival analysis, Cox ratio Risk model to evaluate the prognosis of renal cell carcinoma with renal vein. Results 106 patients were followed up for 93.8% (106/113). The median follow-up time was 61 months (range, 12 to 186 months), 36 patients died, median survival was 127 months (range, 5 to 186 months) The annual cancer-specific survival (CSS) was 61.3% and the 10-year CSS was 50.4%. The Cox proportional hazard model showed that paranodular syndrome (β = 2.457, P = 0.000), Fuhrman classification (β3 = 2.617, P = 0.000) and perirenal fat involvement (β = 1.369, P = 0.002) Is an independent prognostic factor for patients with renal cell carcinoma and renal vein thrombosis, while patients with three risk factors have a median survival of only 14 months. Conclusions The patients with advanced renal cell carcinoma and renal vein aneurysm before operation who underwent open radical nephrectomy combined with tumor embolization had a good prognosis, with prognosis of patients with paraneoplastic syndrome, high Fuhrman grade and perirenal fat involvement difference.