Analysis Of Factors Influencing Recurrence And Prognosis After Partial Resection Of Renal Cell Carcinom

Purpose: As a malignant tumor of urinary system,the incidence of renal cancer is gradually increasing,and the guidelines for the expansion of indications thus make more and more patients choose partial nephrectomy,followed by the problem of postoperative recurrence.Therefore,the recurrence and prognosis of kidney cancer after partial nephrectomy are the focus of research.Previous studies have suggested that inflammatory indicators,coagulation-related indicators and renal function indicators in pathology,hematology and hematology play a role in predicting recurrence and prognosis of patients.Based on this,preoperative inflammatory indicators,renal function related indicators and pathological indicators of patients undergoing partial nephrectomy for renal clear cell carcinoma were included in this study.Survival analysis was used to explore the factors related to recurrence and prognosis of these patients,so as to better manage patients with renal clear cell carcinoma after surgery.Methods:Case collection:A total of 618 patients diagnosed with clear cell carcinoma of kidney after partial nephrectomy in Affiliated Hospital of Qingdao University from September 2013 to December 2017 were retrospectively analyzed.All patients were followed up by telephone and combined with the electronic medical record system for outpatient and inpatient records,and the postoperative recovery,recurrence and metastasis of patients were followed up.A total of 563 patients had complete data and were successfully followed up.55 patients were lost to follow-up,with a follow-up rate of 91.1%.There were 32 patients with recurrence and 531 patients without recurrence.The recurrence rate was 6%,which was basically consistent with the literature reports.Patients were followed up for 57-120 months,with a median follow-up of 81 months.Relapse was considered as an outcome event,and patients were divided into relapse group and non-recurrence group.Observation index:Preoperative and postoperative clinical medical records of the patient included general information(gender,age,BMI),hematological indicators(lymphocyte count,white blood cell count,platelet count,creatinine,hemoglobin count,platelet count,albumin count,fibrinogen count,white globule ratio,D-dimer count),and renal function related indicators(urea nitrogen/creatinine value,and cyone count)The level of statin C),the pathological indicators(Ki-67 positive rate,WHO nuclear grading level),and the fibrinogen to albumin ratio were calculated according to the obtained clinical data.FAR),neutrophil to lymphocyte ratio(NLR)and platelet to lymphocyte ratio(PLR).Statistical method:Receiver operating characteristic curve,ROC)to determine the optimal threshold for lymphocyte count,white blood cell count,platelet count,creatinine count,hemoglobin count,urea nitrogen/creatinine value,albumin count,fibrinogen count,cystatin C level,Ki-67 positive rate,white pellet ratio,D-dimer count,BMI,FAR value,NLR value,and PLR value.SPSS 26.0 and Graph Pad prism 9 were used for statistical analysis.Mann-Whitney U test was used for comparison between measurement data groups.Kaplan-Meier survival method was used for univariate analysis.The Log-rank test was used to compare the survival rate among different groups,and Cox risk regression was used for multivariate analysis.The total survival time of patients with recurrent renal clear cell carcinoma was from the date of diagnosis to the date of recurrence,and the total survival time of patients without recurrent renal clear cell carcinoma was from the date of diagnosis to the end of follow-up.P < 0.05 was considered statistically significant.Result:The 1-year,3-year and 5-year relapse-free survival rates were 99.1%,96.4% and 94.3%.ROC curve result:The optimal critical values of NLR and PLR obtained by ROC curve were 2.54 and 175.6,and the areas under the curve were 0.62 and 0.638,respectively,with statistical significance(P < 0.05).The optimal critical values of BMI calculated were 25.3,and the areas under the curve were 0.64,with statistical significance(P < 0.05).The optimal critical value of cystatin C was 1.00 and the area under the curve was 0.63.The optimal critical value of fibrinogen level was 3.30,and the area under the curve was 0.76.The optimal critical value of Ki-67 positive rate was 9,and the area under the curve was 0.78.The optimal critical value of creatinine level was 79.95 and the area under the curve was 0.75.The optimal critical value of urea nitrogen/creatinine was 13.44 and the area under the curve was 0.65.The optimal critical value of FAR was 0.07 and the area under the curve was 0.71.All the above were statistically significant(P < 0.05).Kaplan-Meier survival analysis result:Kaplan-Meier survival analysis was carried out and survival curves were drawn.Comparison was conducted between the WHO nuclear grading group(Grade 1-2)and WHO nuclear grading group(grade 3-4),and P value of Log-rank test was 0.04.Patients were grouped according to the optimal critical value obtained by ROC curve.Kaplan-Meier survival analysis was performed respectively and survival curves were drawn.Comparison between groups was conducted by Log-rank test.That is,NLR > 2.54,PLR > 175.6,BMI > 25.35,cystatin C level > 1,fibrinogen > 3.35,positive rate of Ki-67 > 9,creatinine level > 79.95,WHO nuclear grade > 2,age >61.FAR ratio greater than 0.07 is an influential factor for postoperative recurrence of patients with renal clear cell carcinoma.Cox risk regression multivariate analysis result:Cox risk regression multivariate analysis of the above single factors showed that there were statistical differences in creatinine level,Ki-67 positive rate,cystatin C,fibrinogen level,WHO nuclear grade,FAR value,age,urea nitrogen/creatinine value(P < 0.05),which were independent risk factors affecting the recurrence of renal clear cell carcinoma after partial renal surgery.Conclusion: Creatinine level,cystatin C level,fibrinogen level,positive rate of Ki-67 and age were positively correlated with recurrence risk and negatively correlated with relapse-free survival.Urea nitrogen/creatinine and FAR were negatively correlated with recurrence risk and positively correlated with relapse-free survival,which were independent risk factors affecting recurrence and prognosis of patients.