| Objective: To understand and analyze the clinical features of different pathological subtypes and the prognostic factors of renal cell carcinoma(RCC).Methods: From January 1,2013 to January 31,2020,a total of 206 patients with thorough clinical,pathological,and follow-up data treated in The Second Affiliated Hospital of University of South China were collected based on the pathological diagnosis of renal cell carcinoma after surgery.The general information,preoperative examination,postoperative pathology,surgical status,and survival status of the 206 patients were accumulated and organized by way of follow-up visits.Different groups were studied based on their different pathological subtypes of renal cell carcinoma,and their clinical medical record’s characteristics and differences.Moreover,through collecting the patient’s survival time,the pertinent factors that may influence the patient’s prognosis were analyzed,and the correlation and prognosis between them were discussed.The Statistical Methods SPSS 23.0 software was used for the statistical analysis of the data.The RXC Fisher’s exact probability method was used for the overall differentiation of the multiple group’s count data.The bonferroni method was used for the paired comparison among groups when there was statistical significance.The Kaplan-Meier method was used for the survival analysis to draw the survival curve and quantify the RCC’s overall survival rate,different pathological subtypes’ survival rates.Furthermore,the Univariate analysis was also conducted for probable prognostic indicators.The Kaplan-Meier method was also used for the univariate analysis,along with the Log-rank method which was used to test the significance of differences.The Multivariate analysis was used to control the T staging,N staging,and tumor pathological subtypes by Cox regression analysis.Significant factors in univariate analysis were analyzed respectively where the test levelα=0.05 and differences were assessed to be statistically significant when P<0.05.Results: 1.Distribution of different pathological subtypes in patients with renal cell carcinoma: 170 cases(82.5%)of clear cell RCC,36 cases(17.5%)of non-clear cell RCC,including 8 cases(3.9%)of the papillary cell,9 cases(4.3%)of chromophobe,and 19 cases(9.2%)of other types of RCC.2.Comparison of clinical data among patients with different pathological subtypes of renal cell carcinoma: Compared with patients with chromophobe,male patients with other types of RCC were more common,which was statistically significant;Compared with patients with clear cell,renal dysfunction was more common in patients with papillary RCC,which was statistically significant.Compared with papillary and clear cells,abnormal albumin globulin ratio was more common in patients with other types of RCC,which was statistically significant.Compared with other types,clear cell RCC was more common in>the 7cm group,lymph node metastasis group,and cystic tumor group.3.The patient’s survival time ranged from 1 to 89 months,with a 30-month median survival time.At the end of the follow-up,out of 206 patients,24 patients(11.7%)died,and 182 patients(88.3%)were still alive.4.The 1-,3-and 5-year overall survival of patients with clear cell RCC was98.1%,90.6%,and 87.7% respectively.The median survival time was 33 months(range 2-89 months);during the follow-up period,no outcome events ensued in patients with Papillary cell RCC.The median survival time of 26 months(range 9-56months);during the follow-up period,no outcome events ensued in patients with chromophobe cell RCC.The median survival time of 20 months(range 2-41 months);The 1-,3-and 5-year overall survival of patients with other types RCC respectively 67.7%,49.2%,36.9% respectively,and the median survival time of 18months(range 1-68 month).The difference in overall survival among different pathological subtypes was statistically significant(P<0.001).5.The probable factors influencing the prognosis of RCC with univariate analysis showed that: the pathological subtype,age,with or without symptoms,history of diabetes,albumin,globulin ratio,fibrinogen,the width of hemoglobin,red blood cells,tumor diameter,T staging,N staging and grade of Fuhrman,tumor necrosis,operation method for the prognosis of patients with statistical significance;6.The factors influencing the overall survival of different pathological subtypes were further studied and were correlated with the T staging and N staging which showed that the lower the stage,the higher the overall survival was and it was not related to age or operation method.The overall survival of clear cell RCC was associated with tumor diameter,presence of clinical symptoms,and tumor necrosis.The overall survival of non-clear cell RCC was affiliated with a history of diabetes and preoperative positive lymph nodes.7.Multivariate analysis exhibited that albumin,fibrinogen,hemoglobin,RBC distribution width,Fuhrman grade,and tumor necrosis were still statistically significant concerning overall survival after controlling the T staging,N staging,and tumor pathological subtypes.Conclusion: 1.The pathological type of RCC was mostly clear cell,accompanied by chromophobe and papillary cell,while other types of RCC were more varied and accounted for less proportion.2.Among different pathological subtypes of RCC,there was a differentiation insex,albumin,albumin ratio,tumor diameter,N staging,and cystic degeneration.3.There is a difference in the prognosis of different pathological subtypes of RCC.Chromophobe cell and papillary cell are the best,followed by clear cell,while other types of RCC are the worst.The overall survival was also associated with T staging and N staging.The lower the staging,the higher the overall survival.To evaluate the prognosis of patients clinically,we should be more attentive to the pathological subtype,postoperative T staging,and N staging of RCC.4.Albumin,albumin globulin ratio,fibrinogen,hemoglobin,red cell distribution width,Fuhrman grade,and tumor necrosis were predictors of overall survival in RCC patients independent of T and N staging and tumor pathologic subtype.Routine blood biochemical indicators are accessible and have a certain significance for renal cell carcinoma’s prognosis evaluation. |
