| Objective: Renal cell carcinoma is a malignant tumor derived from renal tubular epithelial cells.Although cethe cancer can be removed surgically,there will still be recurrence or metastasis,leading to canr-related deaths.Partial removal of normal kidney tissue at the time of surgery increases the risk of postoperative renal insufficiency,which also leads to non-cancer specific mortality.At present,there is still a lack of large sample,long-term and multi-factor studies on the postoperative survival of renal cancer and its influencing factors.The purpose of this study is to investigate the long-term survival and the influencing factors,in order to improve the survival rate of patients and to provide a basis for the perfect postoperative management of renal cell carcinoma.Methods: The clinical data of 176 patients with pathological diagnosis of renal cell carcinoma treated by concurrent surgery from June 2010 to June 2016 were analyzed,and the survival of patients was observed until June 2018.Gender,age,smoking,drinking,side of tumor,tumor diameter,pathological type,TNM stage and grade of Fuhrman,surgical procedure,intraoperative bleeding,operation time,before the operation test results(creatinine,Cystatin C,?2-microglobulin,glomerular filtration rate value,hematuria and proteinuria),high blood pressure,diabetes,and pathological damage of kidney caused by diabetes were included in the possible factors affecting renal cell carcinoma survival.Single factor analysis was carried out by Life Table Methods,and Binary Logistic Regression Model was established to evaluate the prognostic factors.Results: Of the 176 patients admitted,175 were followed up with complete data,with a follow-up rate of 99%.The follow-up time ranged from 1 to 98 months,the median follow-up time was 49 months,and the average follow-up time was 52.03 months.The 1-year,3-year and 5-year survival rates were 92.6%,84.6% and 80.0%,respectively,with an average survival period of 80.7 months.Among the 36 patients who died,33 died due to recurrence or metastasis of renal cancer,2 died due to renal failure combined with heart failure,and 1 died due to acute myocardial infarction.Single factor analysis showed that the survival of renal cell carcinoma was related to age,diabetes mellitus,maximum diameter of tumor,TNM staging,Fuhrman classification,pathological type,operation mode,operation time,preoperative hematuria,preoperative EGFR level,preoperative ?2-globulin level(p<0.05).The Binary Logistic Regression Model was analyzed to show that the survival of renal cell carcinoma was associated with TNM staging [OR=0.324,95%CI(0.135,0.779)],Fuhrman grading [OR=0.753,95%CI(0.605,0.938)],hematuria before operation [OR=0.584,95%CI(0.353,0.965)] and diabetes mellitus [OR=0.145,95%CI(0.039,0.537)](p<0.05).The hosmer-lemeshow test of Binary Logistic Regression Model was 0.861 which meant the model had a high degree of fitting.Effects of pathological damage of kidney caused by diabetes on postoperative survival of renal cell carcinoma: ?level group of 13 cases,4 cases died,?a-class 14 cases,5 cases died;the ?and ?level pathological changes caused by diabetes were no difference on the postoperative survival of patients with renal cell carcinoma,but ?level group average survival period(72.077 ± 20.375 months)overtopped ?grade a group average survival period(68.444 ± 15.318 months).Conclusion: Diabetes mellitus,TNM staging,Fuhrman grading and preoperative hematuria are the independent risk factors for the survival of renal cell carcinoma after operation.and le? ? vel pathological changes caused by diabetes were no difference on the postoperative survival of patients with renal cell carcinoma. |
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