Clinicopathological Features Of Renal Cell Carcinoma And Analysis Of Influencing Factors Of Tumor Specific Survival

Renal cell carcinoma(RCC),accounting for 2%-3% of all adult malignancies,is very common in urninary system.The incidence of kidney cancer in China ranked third after bladder cancer and prostate cancer,and is still on the rise.Prognostic factors of RCC can be classified into: anatomical,histological,clinical,and molecular.Anatomical factors can be gathered together as TNM stage.Histological factors include Fuhrman Grade and intertumoral changes,while histological subtypes of RCC remains controversial.A multicenter study revealed that histological subtype is not an independent factor.Clinical factors include Karnofsky score,symptoms,cachexia,anaemia,and platelet count.Molecular factors are mainly immunohistochemical variables,however,these factors are not recommended in clinical practice.Currently,divergences exist in studies on prognostic factors of RCC,the accuracy of these prognostic systems still needs improvement.Studying prognostic factors of RCC is of vital important for selecting appropriate therapy for individuals with different prognosis.Purpose: The aim of this study is to analyze the clinicopathological data of RCC patients receiveing surgical treatment in our hospital,and find out prognostic factors of RCC.Part I.Clinicopathological Factors of RCCMethods: The clinical and pathological data and follow-up data of primary renal carcinoma patients treated in our hospital from December 2006 to December 2011 were analyzed.Result: The clinicopathological and follow-up data of RCC patients was analyzed in this part.The mean age of included patients(n=369)was 53.4±12.4 yrs,male to femal ratio was 2.6:1,mean body mass index(BMI)was 24.2±3.4.108 patiens(29.3%)were presented with symptoms,including lumbago(16.8%),hematuria(9.8%),palpableabdominal mass(1.1%),while most patiens were asymptomatic(70.7%).21 patients(5.7%)were presented with animia,11patients(3.0%)were presented with elevated aspartate aminotransferase(AST).The mean size of the tumor was 4.6±2.6cm,43patients(11.7%)were with intratumoral bleeding,37 patients(10.0%)were with tumor necrosis,44patients(11.9%)were with cystic degeneration,4 patients(1.0%)were with sarcomatoid change.Venous involvement accounted for 2.4% of all patients.The histological subtypes of RCC included 322(87.2%)clear cell carcinomas,22(6.0%)papillary RCCs,15(4.1%)chromophobe RCCs,9(2.4%)multilocular cystic RCCs and1(0.3%)unclassified RCC.Ki-67 expression level was low in 358 patiens(97.0%),and high in 11 patiens(3.0%).200 patients(54.2%)were Fuhrman Grade 1 or 2,169patients(45.8%)were Fuhrman Grade 3 or 4.342patients(92.7%)were T1/T2 stage,27patients(7.3%)were T3/T4 stage.Age>44yrs,presented with symptoms,anemia,venous involvement and tumor necrosis were associated with advanced T stage(P<0.05),tumor necrosis,sarcomatoid change and high Ki-67 expression level were associated with advanved Fuhrman Grade(P<0.05).Among patients with 5-year follow-ups,27 patients developed distal metastasis.The most common metastatic site was lung,and followed by bone or brain and liver.Conclusion: This study found that the clinical and pathological features of renal cancer in our hospital basically consistent with foreign research.Part II.Factors Influencing Cancer-specific Survival of RCCMethods: The clinical and pathological data of primary renal cell carcinoma patients treated in our hospital from December 2006 to December 2011 were analyzed by univariate and multivariate analysis.Kaplan-Meier method was used to construct the tumor-specific survival curve.Result: The clinical and pathological data of primary renal cell carcinoma patients treated in our hospital from December 2006 to December 2011 were analyzed by univariate and multivariate analysis.Kaplan-Meier method was used to construct the tumor-specific survival curve.Survival data of RCC patients were assessed and factors influencing cancer-specific survival(CSS)were analysized in this part.In uninvariateanalysis,gender,elevated AST,histological subtype and intratumoral bleeding,tumor cystic degeneration had no impact on CSS,while age,BMI,presentation of symptoms,anemia,venous involvement,tumor necrosis,sarcomatoid change,Ki-67 expression level,Fuhrman grade and T stage were risk factors.In Multivariate analysis,venous involvement,tumor necrosis,sarcomatoid change,Ki-67 expression level,Fuhrman grade and T stage were independent factors influencing CSS.In conclusion,the clinicopathologic characteristics of RCC in our study were similar to those of foreign studies.Age,BMI,elevated AST,venous involvement,tumor necrosis,sarcomatoid change,Ki-67 expression level,Fuhrman grade and T stage were independent factors influencing RFS.Venous involvement,tumor necrosis,sarcomatoid change,Ki-67 expression level,Fuhrman grade and T stage were independent factors influencing CSS.