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中华腔镜泌尿外科杂志(电子版) ›› 2024, Vol. 18 ›› Issue (02) : 146 -151. doi: 10.3877/cma.j.issn.1674-3253.2024.02.005

临床研究

淋巴结平均直径与无淋巴结转移肾癌病理特征及预后关系研究
朱显钟1, 李金雨1,(), 于忠英1, 温路生1   
  1. 1. 363000 福建漳州,联勤保障部队第909医院(厦门大学附属东南医院)泌尿外科
  • 收稿日期:2023-03-01 出版日期:2024-04-01
  • 通信作者: 李金雨
  • 基金资助:
    联勤保障部队第909医院青年苗圃(20YQ003)

Relationship between mean lymph node diameter and pathological features and prognosis of renal carcinoma without lymph node metastasis

Xianzhong Zhu1, Jinyu Li1,(), Zhongying Yu1, Lusheng Wen1   

  1. 1. Department of Urology, the 909th Hospital of Joint Logistics Support Force (Dongnan hospital of Xiamen University), Fujian 363000, China
  • Received:2023-03-01 Published:2024-04-01
  • Corresponding author: Jinyu Li
引用本文:

朱显钟, 李金雨, 于忠英, 温路生. 淋巴结平均直径与无淋巴结转移肾癌病理特征及预后关系研究[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(02): 146-151.

Xianzhong Zhu, Jinyu Li, Zhongying Yu, Lusheng Wen. Relationship between mean lymph node diameter and pathological features and prognosis of renal carcinoma without lymph node metastasis[J/OL]. Chinese Journal of Endourology(Electronic Edition), 2024, 18(02): 146-151.

目的

探讨肾癌根治术患者中淋巴结平均直径与临床病理学特征关系及其对预后的影响。

方法

回顾性分析联勤保障部队第九〇九医院2015年1月至2019年6月收治99例行根治性肾切除术的肾癌患者临床病理资料,术后随访3年,根据随访结果分为预后良好组(n=76)和预后不良组(n=23),分析淋巴结平均直径与患者临床病理特征关系,绘制受试工作特征曲线(ROC),计算曲线下面积(AUC),评估淋巴结平均直径对患者预后的预测价值,采用单因素和多因素Logistic回归分析肾癌预后的影响因素。

结果

淋巴结平均直径在肿瘤直径>7 cm、Fuhrman分级3~4级、微血管侵犯、包膜侵犯、肾上腺侵犯、肾周脂肪侵犯患者中增高(P<0.05);淋巴结平均直径预测患者预后的AUC值为0.869,95%CI为0.787~0.951,灵敏度为0.825,特异度为0.750,预测临界值(Cut-off值)为0.555 cm(P<0.05);多因素回归分析显示,肿瘤直径>7 cm(OR=26.722,95%CI=1.721~414.890,P<0.05)、包膜侵犯(OR=6.923,95%CI=1.067~44.927,P<0.05)、静脉侵犯(OR=15.307,95%CI=1.031~227.179,P<0.05)、肾上腺侵犯(OR=44.559,95%CI=3.901~508.967,P<0.05)、淋巴结平均直径>0.555 cm(OR=16.284,95%CI=1.106~239.667,P<0.05)是预后不良的独立影响因素。Kaplan-Meier风险曲线分析发现淋巴结平均直径>0.555 cm患者不良预后累积风险高于淋巴结平均直径≤0.555 cm患者(Log-Rank=22.469,P<0.05)。

结论

无淋巴结转移的肾细胞癌患者中,淋巴结平均直径与不良病理特征相关,并且是患者预后的独立影响因素,在判断预后和制定个体化治疗方案方面可能具有一定的临床意义。

Objective

To investigate the relationship between mean lymph node diameter and clinicopathological features in patients with renal cell carcinoma undergoing radical nephrectomy and its impact on prognosis.

Methods

The clinicopathological data of 99 patients with renal cell carcinoma who underwent radical nephrectomy in 909th Hospital of Joint Logistics Support Force from January 2015 to June 2019 were retrospectively analyzed. All patients were followed up for 3 years. According to the follow-up results, the patients were divided into good prognosis group (n=76) and poor prognosis group (n=23). The relationship between mean lymph node diameter and clinicopathological characteristics of patients was analyzed. The operating characteristic curve (ROC) was drawn, and the area under the curve (AUC) was calculated to evaluate the predictive value of mean lymph node diameter on the prognosis of patients. Univariate and multivariate Logistic regression were used to analyze the prognostic factors of renal cell carcinoma.

Results

The average diameter of lymph nodes was higher in patients with tumor diameter >7 cm, Fuhrman grade 3-4, microvascular invasion, capsule invasion, adrenal invasion and perirenal fat invasion (P<0.05). The AUC value of mean lymph node diameter in predicting the prognosis of patients was 0.869, 95%CI was 0.787-0.951, the sensitivity was 0.825, the specificity was 0.750, and the cut-off value was 0.555 cm (P<0.05). Multivariate regression analysis showed that tumor diameter >7 cm (OR=26.722, 95%CI=1.721-414.890, P<0.05), capsule invasion (OR=6.923, 95%CI=1.067-44.927, P<0.05), venous invasion (OR=15.307, 95%CI=1.031-227.179, P<0.05), adrenal invasion (OR=44.559, 95%CI=3.901-508.967, P<0.05), mean lymph node diameter >0.555 cm (OR=16.284, 95%CI=1.106-239.667, P<0.05) were independent risk factor for poor prognosis. Kaplan-Meier risk curve analysis found that the cumulative risk of adverse prognosis in patients with average lymph node diameter >0.555 cm was higher than that in patients with average lymph node diameter ≤0.555 cm (Log-Rank=22.469, P<0.05).

Conclusions

In patients of renal cell carcinoma without lymph node metastasis, mean lymph node diameter is associated with adverse pathological features and is an independent prognostic factor of patients, which may have certain clinical significance in judging prognosis and making individualized treatment plans.

表1 99例肾细胞癌患者淋巴结平均直径与临床病理特征关系
分组 例数 淋巴结直径[cm,(±s)] 统计值 P
年龄(岁)     -0.981 0.330
≤60 58 0.51±0.06    
> 60 41 0.52±0.08    
性别     0.724 0.471
67 0.51±0.07    
32 0.51±0.07    
BMI(kg/m2)     -0.183 0.885
≤24 33 0.51±0.06    
> 24 66 0.52±0.07    
吸烟     0.489 0.626
39 0.52±0.07    
60 0.51±0.07    
饮酒     -1.312 0.193
47 0.51±0.07    
52 0.52±0.07    
合并糖尿病     -0.015 0.998
84 0.51±0.07    
15 0.51±0.06    
合并高血压     1.323 0.189
79 0.52±0.07    
20 0.49±0.05    
临床症状     -0.936 0.352
28 0.51±0.06    
71 0.52±0.07    
肿瘤部位     0.967 0.336
左肾 48 0.52±0.07    
右肾 51 0.51±0.07    
肿瘤直径(cm)     -1.997 0.049
≤7 62 0.50±0.06    
> 7 37 0.53±0.07    
手术方式     1.142 0.256
腹腔镜 76 0.52±0.07    
开腹 23 0.50±0.06    
Fuhrman分级     -2.647 0.015
1~2级 67 0.49±0.06    
3~4级 32 0.53±0.08    
微血管侵犯     -2.462 0.021
62 0.50±0.11    
37 0.54±0.13    
包膜侵犯     -4.746 <0.001
79 0.45±0.08    
20 0.56±0.15    
静脉侵犯     -0.286 0.557
85 0.53±0.13    
14 0.57±0.14    
肾上腺侵犯     -4.894 <0.001
81 0.44±0.09    
18 0.67±0.11    
肾周脂肪侵犯     -5.293 <0.001
87 0.45±0.09    
12 0.68±0.13    
TNM分期     0.890* 0.622
14 0.50±0.07    
38 0.50±0.06    
28 0.57±0.07    
19 0.50±0.05    
清扫淋巴结数量(枚)     0.115 0.873
≤13 52 0.55±0.10    
> 13 47 0.54±0.14    
图1 淋巴结平均直径预测肾癌患者不良预后的ROC曲线
表2 肾癌术后预后不良单因素分析
表3 肾癌术后预后不良Logistic回归多因素分析
图2 淋巴结平均直径对肾癌预后Kaplan-Meier风险曲线分析
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