本文關鍵詞： 腎盂癌 鱗狀細胞癌 回顧性 Cox回歸模型　出處：《中南大學》2014年碩士論文　論文類型：學位論文

【摘要】：目的：總結(jié)腎盂鱗狀細胞癌臨床、病理特征,從人體測量學指標、臨床病史資料等方面分析影響腎盂鱗狀細胞癌預后的危險因素,比較各因素對腎鱗狀細胞患者腫瘤復發(fā)轉(zhuǎn)移及生存時間的影響,為改善腎盂鱗狀細胞癌患者預后找到行之有效的方法。 方法：采用回顧性分析方法,收集近20年在中南大學湘雅醫(yī)院和中南大學湘雅二醫(yī)院就診,且符合納入標準及排除標準的病例資料,采用電話或短信追蹤隨訪并結(jié)合院內(nèi)已歸檔病例相關資料進行研究,數(shù)據(jù)基本資料的描述采用頻數(shù)和百分比表示。探討影響腎盂鱗狀細胞癌生存的危險因素采用COX回歸模型進行計算。計算不同手術方式、是否化療、腫瘤T分期、腫瘤N分期組等的中位生存時間和生存率差異顯著性比較應用Kaplan-Meier法和Long-rank秩檢驗。 結(jié)果：(1)37例腎盂鱗狀細胞癌患者中,平均診斷年齡為61.0±8.3歲、身高體重指數(shù)(BMI)平均值為19.9±2.2kg/m2,以文化程度低、低收入、基礎衛(wèi)生醫(yī)療設施薄弱地區(qū)的人群居多,且男性多于女性；(2)所有研究對象中,存在腎臟積水和(或)積膿或感染征象者為31例,占入選病例83.8%；存在同側(cè)腎結(jié)石病史患者29例,占入選病例78.3%,其中存在10年以下結(jié)石病史患者14例(占37.8%),存在10年以上結(jié)石病史患者15例(占40.5%)；無結(jié)石病史患者8例(占21.6%)；所有患者中同時存在以上多種危險因素者為25例；(3)根據(jù)Cox回歸模型進行單因素分析,影響預后的影響因素有腫瘤T分期(P=0.004)、腫瘤N分期(P=0.01)、腫瘤分化程度(P=0.01)及確診時間(P=0.004)；逐步篩選模型多因素分析結(jié)果為腫瘤T分期是影響預后的獨立預測因子(P=0.004)。(4)腎鱗癌的腫瘤T分期、腫瘤N分期、腫瘤分化程度是評估術后生存期的可靠指標,相同的腫瘤T分期\N分期以及腫瘤分化程度的患者,無論行什么手術方式和術后放化療處理,生存期都無明顯統(tǒng)計學差異。 結(jié)論：(1)腎盂鱗狀細胞癌中,低文化、低收入、基礎衛(wèi)生醫(yī)療設施薄弱地區(qū),≥50歲人群,男性構(gòu)成比較高。(2)腎結(jié)石、腎臟積水和(或)積膿和(或)感染可伴發(fā)腎盂鱗狀細胞癌,(3)影響預后的影響因素有腫瘤T分期、腫瘤N分期、腫瘤分化程度。(4)腎鱗癌的腫瘤T分期、腫瘤N分期以及腫瘤分化程度是評估術后生存期的可靠指標,相同的腫瘤T分期\N分期以及腫瘤分化的患者,無論行何種手術方式和是否進行術后放化療,生存期都無明顯統(tǒng)計學差異。
[Abstract]:Objective: to summarize the clinical and pathological features of squamous cell carcinoma of renal pelvis and analyze the risk factors influencing the prognosis of squamous cell carcinoma of renal pelvis from the aspects of anthropometric indexes and clinical history. To compare the effects of various factors on tumor recurrence, metastasis and survival time in renal squamous cell carcinoma (RSCC), an effective method was found to improve the prognosis of renal squamous cell carcinoma (RSCC). Methods: retrospective analysis was used to collect the data of patients who had been treated in Xiangya Hospital of Central South University and Xiangya II Hospital of Central South University in the past 20 years, and met the criteria of inclusion and exclusion. The patients were followed up by telephone or short message and studied with the data of the cases filed in the hospital. The basic data were described by frequency and percentage. The risk factors affecting the survival of squamous cell carcinoma of renal pelvis were calculated by COX regression model. The median survival time and survival rate of T staging group and N stage group were significantly different by Kaplan-Meier and Long-rank rank test. Results in 37 patients with squamous cell carcinoma of renal pelvis, the average age of diagnosis was 61.0 鹵8.3 years, and the mean value of BMIs was 19.9 鹵2.2 kg / m2. In the areas with low education, low income, weak basic health care facilities, the majority of the population, and more men than women; (2) among all the subjects, there were 31 cases with hydronephrosis and / or pyosis or infection, accounting for 83.8% of the selected cases. There were 29 cases with history of ipsilateral renal calculi, accounting for 78.3% of the selected cases, of which 14 cases (37.8%) had a history of less than 10 years of lithiasis. 15 patients (40.5%) had a history of lithiasis for more than 10 years. 8 cases (21.6%) had no history of lithiasis; Among all the patients, 25 cases had multiple risk factors. (3) univariate analysis based on Cox regression model showed that the influencing factors of prognosis were tumor T stage P0. 004, tumor N stage P0. 01). The degree of differentiation of the tumor was 0.01) and the time of diagnosis was 0.004%. Multivariate analysis of stepwise screening model showed that tumor T stage was an independent prognostic factor for prognosis of renal squamous cell carcinoma (RSCC). The degree of tumor differentiation is a reliable index to evaluate postoperative survival. Patients with the same tumor T / N stages and tumor differentiation degree, no matter what operation mode and postoperative radiotherapy and chemotherapy treatment. There was no significant difference in survival time. Conclusion: in squamous cell carcinoma of renal pelvis, low education, low income, weak basic health and medical facilities, and more than 50 years old, the composition of male is relatively high. The prognostic factors of hydronephrosis and / or pyosis and / or infection associated with squamous cell carcinoma of renal pelvis were T stage and N stage of tumor. The tumor T stage, tumor N stage and tumor differentiation degree of renal squamous cell carcinoma (RSCC) were reliable indexes to evaluate postoperative survival, same tumor T staging / N stage and tumor differentiation. There was no significant difference in survival between the two groups.
【學位授予單位】：中南大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R737.11

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本文編號：1467132