| The objective: The aim to explore the influence of lymph node dissection on the survival of renal cancer patients with different TNM stages and to provide clinical basis for accepting lymph node dissection for renal cancer patients.The method: The clinical and pathological materials of two hundred and seven patients with renal cell carcinoma from January 2004 to December 2017 in the Second Affiliated Hospital of South China University were collected.And they all met the inclusion criteria.The data collected by us included: sex,age,smoking,whether to carry other diseases(such as hypertension,diabetes,coronary heart disease),operation method,tumor side,tumor size,TNM stage,Fuhrman grade,pathological type,intraoperative blood loss,whether to resect ipsilateral adrenal gland,complications after operation,etc.According to TNM stage and clinical stage,all cases were divided into three stages.They were respectively localized renal carcinoma(T1N0M0,T2N0M0),locally advanced renal carcinoma(T1-2N1M0,T3N0-1M0),metastatic renal carcinoma(T4N0-1M0,T1-4N0-1M1).In all stages,according to different degrees of lymph node dissection during operation,renal cell carcinoma may be divided into renal cell carcinoma resection group,renal cell carcinoma resection plus regional lymph node dissection group and renal cell carcinoma resection plus enlarged lymph node dissection group.All included cases were grouped according to some factors,such as age,sex,Fuhrman grade,pathological type and other reasons.The influence of the above data on the long-term survival time,survival rate and prognosis of patients were analyzed by some statistical methods,such as Kaplan-Meier survival analysis,multivariate Cox regression analysis and other methods.The result: Kaplan-Meier survival analysis,a single factor analysis,meant that lymph node dissection was a important factor on affecting the survival time and survival rate of renal cell carcinoma patients in locally advanced renal cell carcinoma.However,lymph node dissection was not a factor on affecting the survival time and survival rate of renal cell carcinoma patients in localized and metastatic renal carcinoma.Kaplan-Meier survival analysis,a single factor analysis,meant that TNM stage,Fuhrman grade,pathological type,age and tumor size were the factors on affecting the prognosis of patients,survival time and survival rate of renal cell carcinoma.The influence factors with the significance of statistics by the above Kaplan-Meier analysis were carried out Cox multivariate analysis.It meant that TNM stage,Fuhrman grade,pathological type,age,lymph node dissection(locally advanced renal cancer)and other factors were independent risk factors affecting the total survival time and survival rate of renal cancer patients after surgery.There was statistical significance.The conclusion: 1.The difference of the overall survival time and survival rate of patients with localized renal carcinoma treated by Lymph node dissection has not statistical significance.We advise that patients with localized renal carcinoma should be treated by lymph node dissection only when lymph node enlargement is abnormal in imaging data or clear lymph node enlargement is found during surgery.2.The difference of the overall survival time and survival rate of patients with locally advanced renal carcinoma treated by Lymph node dissection is obvious.There was the significance of statistics.In locally advanced renal cell carcinoma,the total survival time and survival rate of renal cell carcinoma resection plus extended lymph node dissection group are obviously superior to those of renal cell carcinoma resection plus regional lymph node dissection group and simple renal cell carcinoma resection group.Renal cell carcinoma resection plus extended lymph node dissection is suggested to patients with locallyadvanced renal cell carcinoma.3.In this study,The difference of the overall survival time and survival rate of patients with metastatic renal cancer treated by Lymph node dissection has not statistical significance.It may be inconsistent with other current conclusions.The reasons may be the difference of patients' own physical quality and sample size.The two factors make the difference of the observation result.After combining with relevant data,we think that lymph node dissection may exit better survival advantages for patients with longer life expectancy,good physical state and lower risk factors.4.TNM stage,Fuhrman grade,pathological type,age and lymph node dissection(locally advanced renal cancer)are independent risk factors on affecting the total survival and survival rate of renal cancer patients. |
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