目的：探讨CT征象与肾癌患者生存率的关系，评估预后价值。材料和方法：回顾性分析经手术及病理证实的208例肾透明细胞癌的CT征象，包括与肿瘤T分期相关和不相关的两类CT征象。通过相关的CT征象进行T分期，相关CT征象由于肿瘤对肾周围结构侵犯程度不同，出现假阴性、阳性两类CT征象，导致分期误差,利用Kaplan-Meier法对误差较大T3a期的两类患者的生存率进行分析，率的比较采用卡方检验，得出生存曲线；临床、组织学类型及CT征象与生存率的关系采用Kaplan-Meier法，率的比较采用卡方检验，对有统计学意义的单因素采用COX模型行多因素分析。结果：CT-T分期主要误差在T3a期，66例T3a期患者中，包括42例T3a-CT、24例T3a-仅病理两组患者，CT分期T3a-仅病理患者分布在T1期（6例）、T2期（18例）。T3a-CT患者与T3a-仅病理或T2-病理患者在5年生存率上存在显著差异（P＜0.05），而T3a-仅病理患者与T2-病理患者在5年生存率上差别不大（P＞0.05），且三组的生存曲线没有交叉。单因素分析结果显示组织学类型、肿瘤大小、肿瘤是否穿透肾被膜、肾窦有无受侵、肾静脉及分支有无受侵、下腔静脉有无受侵、肿瘤有无广泛性坏死、肿瘤有无囊变、瘤周有无受侵及瘤周有无新生血管等相关与5年生存率相关（P＜0.05），多因素分析显示组织学类型、肿瘤大小、肿瘤是否穿透肾被膜、肾静脉及分支有无受侵、下腔静脉有无受侵、肿瘤有无囊变、瘤周有无受侵及瘤周有无新生血管是影响肾透明细胞癌预后的相对独立危险因素（P＜0.05）。结论：肾透明细胞癌的肿瘤大小、肿瘤是否穿透肾被膜、肾静脉及分支有无受侵、下腔静脉有无受侵是影响预后的相对独立危险因素，在T3a期同种CT征象中，假阴性较阳性CT征象预后好；肿瘤有无囊变、瘤周有无受侵及瘤周有无新生血管是影响肾透明细胞癌预后的相对独立危险因素，瘤周受侵及瘤周新生血管形成降低生存率，而肾癌囊性变则是肿瘤预后良好的标志。
Abstract
Objective: To investigate the relationship between CT features and the survival rate of patients with RCC, and to evaluate its prognostic value. Methods: The CT findings of 208 cases of renal clear cell carcinoma confirmed by surgery and pathology were retrospectively analyzed, including two types of CT features relevant to tumor T staging or not. CT features associated with stage T could be false negative or positive due to the degrees of aggression, leading to errors in staging. The survival of T3a patients were evaluated. Relationship of clinical data, histological types and CT signs was evaluated with survival rate by Kaplan-Meier survial analysis to obtain the survival curve. The comparison of survival rate was tested by chi-square test. For statistically significant single factors, multifactor unconditional logistic regression analysis was adopted to make a COX model. Results: The critical error of CT-T staging was in T3a stage. There were 42 T3a-CT patients and 24 T3a patients(only pathological diagnosis) in all 66 T3a patients. The latter had 18 patients in T2 stage and 6 patients in T1 stage on CT stage. The patients of T3a stage diagnosed by CT were different from the patients of T3a stage only diagnosed by pathology or the patients of T2 stage in survival rates(P<0.05). The patients of T2 stage showed no significant difference with the patients of T3a stage only diagnosed by pathology(P>0.05), and there was no overlapping between the survival curves in the three groups. Single factor analysis results showed that 5 year survival rate of renal cancer was closely related to histological types, tumor size, renal capsule penetration, renal sinus invasion, renal vein invasion, inferior vena cava invasion, extensive necrosis of tumor, cystic degeneraton of tumor, peritumoral invasion, peritumoral neovascularity. Multifactor logistic regression showed that the prognosis of patients with renal clear cell carcinoma was closely related to histological types, tumor size, renal capsule penetration, renal vein invasion, inferior vena cava invasion, cystic degeneraton of tumor, peritumoral invasion, peritumoral neovascularity(P<0.05). Conclusion: Tumor size, renal capsule penetration, renal vein invasion, and inferior vena cava invasion were relatively independent risk factors for renal clear cell carcinoma. The false negative CT sign showed better prognosis than the positive CT feature in T3a. Cystic degeneration, peritumoral invasion, and peritumoral neovascularity were relatively independent risk factors. Peritumoral stranding and peritumoral neovascularity reduced the survival rate. Cystic degeneration is a sign of good prognosis.
关键词
肾肿瘤 /
腺癌 /
透明细胞 /
体层摄影术 /
螺旋计算机
Key words
Kidney neoplasms /
Adenocarcinoma, clear cell /
Tomography, spiral computed
中图分类号：
Ｒ737.11
Ｒ730.261
Ｒ814.42
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