分析不同分型乳头状肾细胞癌（pRCC）的临床特征及治疗效果，探讨pRCC预后相关危险因素。

回顾性收集了中山大学孙逸仙纪念医院2011年1月至2021年10月经微创手术治疗且病理确诊的70例pRCC患者的临床及病理资料。所有患者术前已排除远处转移，并对患者生存及复发转移情况进行跟踪随访，随访至2021年12月底，以出现疾病进展或任何原因的死亡为终点。采用Kaplan-Meier法绘制生存曲线，COX回归用于多因素分析无进展生存（PFS）的危险因素。

70例患者均诊断为pRCC，包括21例Ⅰ型及49例Ⅱ型，其中男55例，中位年龄57岁。中位肿瘤直径为4.0 cm（Q₁~Q₃：2.9~6.3 cm）。肿瘤TNM分期：pT₁期52例，pT₂期7例，pT₃期10例及pT₄期1例，Ⅰ型及Ⅱ型患者肿瘤直径（4.0 cm vs 4.0 cm）及pT分期差异无统计学意义。Ⅰ型患者中1例伴癌栓，Ⅱ型患者中9例伴癌栓，7例淋巴结转移患者均为Ⅱ型。肿瘤侵犯肾包膜34例，含31例Ⅱ型（P<0.001），Ⅱ型患者WHO/ISUP分级显著高于Ⅰ型（P<0.001）。总体中位随访时间46个月，Ⅰ型和Ⅱ型pRCC患者中位随访时间分别为43个月和51个月。5年无进展生存率分别为100%和67.3%，Kaplan-Meier生存分析示Ⅰ型pRCC患者PFS优于Ⅱ型（P<0.05）。Cox多因素分析发现肿瘤直径与pRCC的PFS相关，此外术前碱性磷酸酶异常亦与Ⅱ型pRCC的PFS相关。

Ⅱ型pRCC较Ⅰ型核分级更高，更易发生包膜入侵，更易发生疾病进展。直径较大的pRCC患者预后更差，术前碱性磷酸酶异常是Ⅱ型pRCC的独立危险因素。

To analyze the clinical characteristics and therapeutic effects of different subtypes of papillary renal cell carcinoma (pRCC), and to explore the prognostic risk factors related to pRCC.

The clinical and pathological data of 70 patients with pRCC who were treated by minimally invasive procedure and confirmed pathologically from January 2011 to October 2021 in Sun Yat-sen Memorial Hospital of Sun Yat-sen University were retrospectively collected. All patients were excluded from distant metastasis before surgery, and their survival, recurrence, and metastasis were followed up until the end of December 2021, with disease progression or death from any cause as the endpoint. The Kaplan Meier method was used to plot the survival curve, and COX regression was used for multivariate analysis of risk factors for progression free survival (PFS).

All 70 patients were diagnosed with pRCC, including 21 cases of type I and 49 cases of type II, including 55 males, all patients with a median age of 57 years. The median tumor diameter is 4.0 cm (Q₁~Q₃: 2.9-6.3 cm). Tumor TNM staging: 52 cases in pT₁ phase, 7 cases in pT₂ phase, 10 cases in pT₃ phase, and 1 case in pT₄ phase. There was no significant difference in tumor diameter (4.0 cm vs 4.0 cm) and pT staging between type I and type II patients. One patient was accompanied by a tumor thrombus in type I, 9 patients were accompanied by a tumor thrombus in type II, and 7 patients with lymph node metastasis were all type II patients. There were 34 cases of tumor invasion of renal capsule, including 31 cases of type II (P<0.001). The WHO/ISUP grading of type II patients was significantly higher than that of type I (P<0.001). The overall median follow-up time was 46 months, with a median follow-up time of 43 months for type I and 51 months for type II pRCC patients, respectively, the 5-year progression free survival rates were 100% and 67.3%, respectively. Kaplan Meier survival analysis showed that PFS in type I pRCC patients was significantly better than that in type II pRCC patients (P<0.05). Cox multivariate analysis showed that the tumor diameter was significantly related to the PFS of pRCC, and the preoperative alkaline phosphatase abnormality was also significantly related to the PFS of type II pRCC.

Type II pRCC has a higher nuclear grading than type I, which is more prone to capsule invasion, and more prone to disease progression. The prognosis of patients with larger diameter pRCC is worse, and abnormal preoperative alkaline phosphatase is an independent risk factor for type II pRCC.