Analysis Of Clinicopathological Features And Prognosis Of Chromophobe Renal Cell Carcinoma In 127 Cases

ObjectiveRenal cell carcinoma is a frequent tumor of the urinary system.The incidence of renal cell carcinoma is second only after bladder cancer,accounting for about 2%³%of tumor in adults.The pathology of renal cell carcinoma can be sorted as the common papillary renal cell carcinoma,chromophobe renal cell carcinoma,hereditary renal cell carcinoma?VHL syndrome,hereditary renal papillary adenocarcinoma,hereditary leiomyomatosis renal cell carcinoma,Birt-Hogg-Dube syndrome?and the other rare sporadic renal cell carcinoma?Bellini collecting duct carcinoma,renal medullary carcinoma,sarcomatoid renal carcinoma,multilocular cystic renal carcinoma,ectopic renal carcinoma,mucinous tubular and spindle cell carcinoma?.Chromophobe renal carcinoma,ChRCC was first reported by Thoenes etc.in 1985,which is a kind of less common RCC that have a favorable prognosis.Different subtypes of renal cell carcinoma have unique clinical and pathological features,and the prognostic factors are also various.There are papers reported that the prognosis of chromophobe renal cell carcinoma is better than the prognosis of papillary carcinoma and clear cell renal cell carcinoma,which is in accordance with our clinical observations.Through the study of chromophobe renal cell carcinoma,clinical data,pathological characteristics,diagnosis and treatment and survival time were analyzed to investigate the prognostic factors of chromophobe renal cell carcinoma patients.Subjects and methodsA retrospective analysis from September 2011 to September 2016 in our hospital127 cases of ChRCC patients were reviewed and their clinicopathological data as well as the follow-up investigations were analyzed respectively,59 cases were male,68were female,male to female ratio was 1:1.17.The onset age is 24⁸7 years,the average onset age is 51.65±12.26 years.Our research involved the analysis of the clinical characteristics,onset age,sex,clinical presentations,tumor location,tumor size,TNM stage,diabetes,hypertension and other complications,surgical approach,radical resection,postoperative recurrence,lymph node metastasis,distant metastasis,and postoperative application of interleukin-2 on survival time and prognosis.SPSS20 statistics software was applied to analysis the data,T test and Kruskal-Wallis H test were used to the measurement data groups.Chi square test or Fisher accurate test was used to the count data groups.The end point of the research was the death of the patients.Kaplan-Meier survival curve was applied to estimate the survival rate.Prognostic factors were assessed by the Log-rank test.The overall survival?OS?rates were calculated by Kaplan-Meier method and Cox regression model was used to analyze the relationship between the clinicopathological influencing factors and the prognosis.ResultsIn this group,127 cases were followed up for 6⁶7 months,and the median follow-up was 28.7 months,the overall follow-up rate was 94.5%.Tumor staging according to 2010 AJCC TNM staging system was pT1 in 93?73.2%?,pT2 in25?19.7%?,pT3 in 6?4.7%?and pT4 in 3?2.4%?.The average size of lesion was1¹3.3 cm.with median at 5.38cm.Single factor analysis showed that relapse after surgery?P<0.001?,T stage?P=0.006?according to 2010 AJCC TNM staging system,distant metastasis?P<0.001?and lymph node metastasis?P<0.001?were significant prognostic factors in Log-rank test while the sex?P=0.116?,age above 50years old?P=0.257?,tumor side?P=0.751?,the first clinical visit with manifestations?P=0.942?,the maximum diameter of the tumor above 7cm?P=0.352?,surgery approach?P=0.339?,radical resection?P=0.234?,postoperative use of interleukin-2?P=0.416?,patients with hypertension?P=0.203?,and diabetes?P=0.561?have nothing to do with the prognosis of chromophobe renal cell carcinoma.According to the Cox multivariate analysis,radical nephrectomy?P=0.563?and distant metastasis?P=0.119?may be the possible risk factors for the patient's survival.The patients cannot benefited from the IL-2 after surgery?P=0.18?.Lymph node metastasis?OR=36.69,P<0.0010?was the independent predictive factor.ConclusionChRCC is a distinct subtype of renal cell exhibiting a low degree of malignancy,the pT₁ and the pT₂ cases are dominant in all cases,which may be relative to the better prognosis.Patients do not benefit from the use of interleukin-2 after the operation?P=0.018?,Lymph node metastasis is the independent prognostic factor of prognosis of ChRCC according to the Cox multivariate analysis.