| Objectives:To analysis the clinical features of renal cell carcinoma and to explore prognostic factors of renal cell carcinomaMethods:We retrospectively reviewed the records of clinical features about 1325 patients with renal cell carcinoma underwent surgery between January 1, 2008 and December 31, 2013 in Tianjin Medical University Cancer Institute and Hospital. We followed up all the patients via making a call or the records of reexamination to know conditions of patients. We have successfully visited 1220 cases that have complete case data,the follow-up rate is 92.1%.Mean follow-up was 40 months(range 2 mo to 87 mos). Neutrophil-to-lymphocyte ratio(NLR) and platelet-to-lymphocyte ratio(PLR) were calculated according to the neutrophil counts, lymphocyte counts and platelet counts. The optimal cutoff values for NLR and PLR were determined using receiver operating curve(ROC) analysis. The cutoff points of NLR and PLR were 2.7 and 138, respectively. 2.7 and 138 were selected as the optimal cutoff value to differentiate between low NLR, high NLR and low PLR, high PLR. All the patients were stratified into two groups respectively according to several factors including the patients diagnosed with or without symptoms,low or high NLR, low or high PLR to analyses their clinical and pathological features and proportion differences between different groups. Recurrence-free-survivals and overall survivals were estimated as the time from surgery to the event, or last follow-up. Survival curves were constructed by the Kaplan-Meier method. Univariate survival analysis was done with the log rank test. Multivariate analysis was performed using Cox regression analysis and the associated 95% confidence interval was calculated. All statistical analyses were performed using SPSS 20.0. All P values are 2-tailed with P<0.05 considered statistically significant.Results: 1. Basic clinical features of renal cell carcinoma: Of all the 1325 cases, 875 were male and 450 were female. Average age was 55 years old, rang from 11-85 years old. All the patients were without history of active bleeding, seriously infection, disseminated intravascular coagulation(DIC), heparin therapy, connective tissue disease or transfusion in 3 months before surgery. 837(63.2%) cases were asymptomatic and 488(36.8%) cases with‘‘ the three typical symptoms of renal cell carcinoma. 513(38.7%) cases were with history of smoking and 812 cases were without; There were 475(35.8%) patients with history of hypertension and 166(12.5%) with diabetes and133(10.0%) patients with history of family cancer. There were 850(64.2%) patients without history of hypertension and 1159(87.5%) without diabetes and 1192(90.0%) patients without history of family cancer.2. Pathology features of renal cell carcinoma: Tumor stage was determined according to the 2009 AJCC TNM classification of malignant tumors. Tumor grade was determined according to 1982 Fuhrman grade. Pathology type was determined according to 2004 WHO standard. There were 995, 178, 122, and 30 cases in p T1, p T2, p T3 and p T4 respectively. There were 1011 clear cell carcinoma cases. There were 60, 717, 209, and 12 cases in Fuhrman grade 1, 2, 3 and 4 respectively.3. The mean value of hemoglobin and lactate Dehydrogenase were 140.9g/L, 184.6U/L respectively. The cutoff points of NLR and PLR were 2.7,138, respectively.4. The overall survival rates of 3 years, 5 years were 91.3%, 86.9%. The recurrence-free survival rates 3 years,5 years were 88.2%,85.8%.5. Age>65, presentation mode with symptom, higher tumor stage, higher Fuhrman grade, NLR ?2.7 and PLR?138 significantly correlated with poor OS on univariate analysis. Multivariate analysis revealed that higher tumor stage, preoperative NLR ?2.7 and PLR?138 at diagnosis were poor independent prognostic factors of renal cell carcinomaConclusion: 1.The asymptomatic RCC is usually of localized lesion, lower TNM stage Routine health examination could be an important method to detect early stage RCC. Radical nephrectomy is the most often used surgical technique for the treatment of renal cell carcinoma.2. Tumor stage, presentation mode with symptom, high NLR and high PLR in renal cell carcinoma are independent prognostic factors, which should be in the strategy of operation and follow-up. |
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