Analysis Of Clinical Features Of Stage T1 Renal Carcinoma And The Preliminary Study Of Molecular Biological Markers About High Risk Type

Objective:To evaluate the clinicopathological characteristics of cT1 stage renal carcinoma,study the influencing factors related to postoperative prognosis of cT1 stage renal carcinoma,establish the prediction model of postoperative recurrence and tumor-specific death of cT1 stage renal carcinoma and to preliminary explore the molecular markers associated with adverse prognosis of cT1 stage renal carcinoma,in order to guide clinical practice.Methods:In the first part,patients with stage cT1 renal cell carcinoma were included,and the size of renal tumor was regrouped to analyze the clinicopathological characteristics,and the follow-up long-term survival was recorded for statistical analysis,so as to explore the clinicopathological characteristics and prognostic related factors of patients with stage cT1 renal cell carcinoma.To establish a survival prediction model and evaluate the factors affecting the prognosis of patients with stage cT1 renal cell carcinoma.In the second part,according to the data of stage cT1 renal cancer in the first part of our study,formalin-fixed and paraffin-embedded archived specimens of patients with stage cT1 renal clear cell carcinoma with postoperative recurrence and metastasis and patients without recurrence and metastasis were selected as the control study.The expression levels of CX3CR1,SETD2,HIF-2α,PBRM1,HMGB1 and IL-6 were detected by immunohistochemical assay,in order to provide a way to predict the prognosis of cT1 renal clear cell with molecular markers.Results:The cancer-specific survival rates of 2353 patients with cT1 stage renal carcinoma were 98.6%,94.1%,91.5% and 90.5%,respectively,after 1,3,5 and 7 years.10 variables including age,R.E.N.A.L.score,tumor size,preoperative metastasis,postoperative ascending stage to T3,pathological grade,postoperative treatment,postoperative pathological invasion of capsule,postoperative microvascular invasion,and surgical method were independent prognostic factors for the RCC-specific survival risk probability of cT1 stage.Among 2326 patients with cT1 stage renal cancer without preoperative metastasis,the recurrence-free survival rates at 1,3,5and 7 years were 97.4%,93.3%,91.9% and 91.4%,respectively.11 variables,including age,R.E.N.A.L.score,tumor size,BMI,postoperative ascending stage to T3,pathological grade,postoperative treatment,postoperative pathological invasion of capsule,microvascular invasion,surgical method,and pathological type,had significant effects on the survival without recurrence.The nomogram was drawn and a prediction model was established.The model was verified by calculating the C-index value and the effect of the model was good.The tumor size of 3.6cm was the critical point for the prognosis of cT1 renal cancer,while NLR and PLR played no significant role in predicting the prognosis of cT1 renal cancer.The expression of CX3CR1 and IL-6 was significantly different among patients with different prognosis.Conclusion:According to the study of univariate and multivariate correlation survival analysis,the prediction model established according to the correlation factors has been corrected,which was consistent with the results of Cox multivariate analysis,indicating that the new prediction model has certain accuracy and promotion value.The expression of CX3CR1 and IL-6 in patients with high-risk and low-risk groups had obvious difference,the other four index expression was no significant difference.It is suggested that CX3CR1 and IL-6,which two biological markers related to inflammation,may have a certain predictive effect on the prognosis of early renal cancer,and the study of inflammation and poor prognosis of tumor may be a direction worthy of further study.