Analysis Of Clinical Characteristics And Prognostic Factors Of High-risk Small Renal Carcinoma

Purpose: To analyze the clinical and pathological characteristics of high-risk small renal carcinoma,and explore the clinical high-risk factors that affect the recurrence,metastasis,or death of high-risk renal carcinoma,in order to provide individualized diagnosis and treatment basis for the clinical treatment of high-risk small renal carcinoma.Methods: Retrospective analysis of clinical and pathological data of special small renal cell carcinoma diagnosed in our hospital from August 1,2012 to August 1,2019 and confirmed by surgery and pathology.Statistical analysis of preoperative blood system abnormalities such as hemoglobin concentration,albumin concentration,neutrophil to lymphocyte ratio,etc,and surgical method,tumor location,pathological type,perinephric sinus fat,venous cancer thrombus,or pyelopenic clinical and pathological characteristics such as invasion,nuclear grading,tissue necrosis,lymph node or distant metastasis,basic lesions,and prognosis.SPSS23.0 statistical software was used for data analysis,Kaplan-Meier method was used for univariate analysis,and Log-Rank test was used to determine whether it was statistically significant.Cox regression multivariate analysis screened factors that significantly affectedthe progression or death.P <0.05 was considered statistically significant.Results: A total of 71 patients with high-risk small renal carcinoma were followed up,including 40 males and 31 females.The age ranged from 30 to 80 years,with an average age of(61.22 � 11)years old.The tumors were 2 to 4 cm in diameter,with an average of 3.33 cm.71 patients was followed-up,including 64 cases with renal clear cell renal cell carcinoma,1 case with MIT family heterotopic renal carcinoma,1 case with papillary renal carcinoma,1case with papillary renal carcinoma,1 case with renal neuroendocrine carcinoma with renal pelvis carcinoma,2 case with unclassified renal carcinoma and 1 case with suspected color cell carcinoma.WHO/ISUP nuclear grading of postoperative pathology showed that grades I-IV are 1,33,29,8 cases respectively.There were 4 cases with local lymph node metastasis and 4 cases with bone metastasis.Postoperative clinical staging was T1aN1M0 in 3 cases,T1aN0M1 in 2 cases,T3aN0M0 in 62 cases,T3bN0M0 in 1 case,T3aN1M0 in1 case,and T3aN0M1 in 2 cases.The follow-up period is from the range of 4 to88 months.8 patients had recurrence and metastasis,4 were bone metastases,2were lung metastases,and 2 recurred in the operation area among them.There were 6 patients died,including 3 died of bone metastasis,2 died of brain metastasis,and 1 died of lung metastasis.Univariate analysis found that advanced age(over 60 years old),clinical symptoms,tumor diameter> 3cm,peripheral blood NLR ?2.067,WHO / ISUP nuclear grade 3-4,hypertensionhave significant effect on the prognosis of high-risk small renal carcinoma patients(p <0.05).Cox multivariate analysis showed that advanced age(over60 years old),clinical symptoms,peripheral blood NLR ?2.067,tumor diameter> 3 cm,WHO / ISUP nuclear grade 3-4 are independent risk factors on the progression or death of high-risk small renal carcinoma(p <0.05).Conclusion: A small number of high-risk small renal carcinoma can manifest as aggressive growth,with local invasion,lymph node metastasis,or distant metastasis at an early stage.Advanced age(over 60 years old),symptomatic kidney cancer,neutrophil-to-lymphocyte ratio ? 2.067,tumor diameter greater than 3cm,WHO/ISUP nuclear grade 3-4,hypertension are more prone to progression or death.Advanced age(over 60 years old),clinical symptoms,peripheral blood NLR ?2.067,tumor diameter> 3 cm,WHO / ISUP nuclear grade 3-4 are independent risk factors on the progression or death of high-risk small renal carcinoma.Surgery and follow-up treatment should be individualized according to specific circumstances.