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目的:评估2010年新版TNM分期系统能否更准确预测肾透明细胞癌(RCC)患者的预后以及其在临床应用中的价值。方法:回顾性总结1 216例经行根治性或部分性肾切除术的肾透明细胞癌患者。所有患者均经病理证实为肾透明细胞癌(肾癌),均经过2002年版和2010年新版TNM分期系统分别进行分期并收集患者生存期数据。通过单因素和多因素Cox回归模型评估患者特异性生存期(CSS)和无进展生存时间(PFS)。通过Kaplan-Meier法分析患者的生存期数据,通过log-rank检验评估各分期的组间差异。结果:应用2010年新版TNM分期系统,T3a期和T3b期两亚组之间CSS和PFS差异存在显著统计学意义(P<0.001)。根据新版分期,原T3b期患者中肿瘤侵犯肾静脉归入T3a期与仍留在T3b期相比,CSS和PFS具有显著性差异,而原T3a期患者中肿瘤侵犯肾上腺归入T4期与仍留在T3a期相比,CSS和PFS的比较也具有统计学差异(P<0.001)。结论:与2002年版TNM分期系统相比,2010年新版TNM分期系统可更准确地预测RCC患者的预后。
Objective: To assess whether the new 2010 TNM staging system can predict the prognosis of patients with renal clear cell carcinoma (RCC) more accurately and its value in clinical application. Methods: A retrospective review of 1 216 patients with clear cell renal cell carcinoma or radical nephrectomy in patients with clear cell carcinoma. All patients were pathologically confirmed as clear cell renal cell carcinoma (renal cell carcinoma). All of them were staged separately and the patient’s survival data were collected after the 2002 and 2010 new TNM staging system respectively. Patient-specific survival (CSS) and progression-free survival time (PFS) were assessed by univariate and multivariate Cox regression models. Survival data were analyzed by Kaplan-Meier method and the differences between groups were assessed by log-rank test. Results: With the new TNM staging system in 2010, there were significant differences in CSS and PFS between the two subgroups of T3a and T3b (P <0.001). According to the new staging, there was a significant difference between CSS and PFS in terms of tumor invasion of the renal vein in the original T3b stage compared with that in the T3b stage, whereas the tumor invasion into the T4 stage in the original T3a stage remained with T4 There was also a statistically significant difference between CSS and PFS in T3a (P <0.001). CONCLUSIONS: Compared with the 2002 TNM staging system, the new 2010 TNM staging system predicts the prognosis of patients with RCC more accurately.