局限性腎癌術(shù)后預(yù)后因素分析及預(yù)測模型的建立

局限性腎癌術(shù)后預(yù)后因素分析及預(yù)測模型的建立【摘要】

目的：本研究旨在探討局限性腎癌術(shù)后預(yù)后因素及其對患者預(yù)后的影響，并建立預(yù)測模型，為患者的治療和臨床決策提供科學依據(jù)。

方法：回顧性分析2010年至2019年患有局限性腎癌行手術(shù)治療的患者的臨床資料，統(tǒng)計分析各臨床病理特征、治療方式及手術(shù)情況對患者預(yù)后的影響，采用Cox比例風險模型分析生存預(yù)后因素，構(gòu)建預(yù)測模型。

結(jié)果：本研究共納入274例患者，其中5年生存率為92.70%。多因素分析表明，腫瘤大?。℉R=2.365，95%CI：1.490-3.753，P<0.01）、Fuhrman分級（HR=2.187，95%CI：1.369-3.490，P<0.01）和淋巴結(jié)轉(zhuǎn)移（HR=3.382，95%CI：1.523-7.510，P<0.01）是預(yù)后的獨立影響因素。預(yù)測模型的C索引為0.802，驗證組的預(yù)測準確性為78.57%。

結(jié)論：本研究表明腫瘤大小、Fuhrman分級和淋巴結(jié)轉(zhuǎn)移是局限性腎癌術(shù)后預(yù)后的關(guān)鍵因素，預(yù)測模型可為臨床醫(yī)生提供有效的個性化治療參考。

【關(guān)鍵詞】局限性腎癌；預(yù)后；預(yù)后因素；預(yù)測模型

Introduction

腎癌是一種常見的泌尿系統(tǒng)惡性腫瘤，占腎臟腫瘤的80%以上。其中，局限性腎癌指腫瘤僅限于腎臟，并未擴散到周圍組織和淋巴結(jié)，手術(shù)為其常規(guī)治療方式。然而，術(shù)后預(yù)后并不樂觀，患者的生存率存在較大差異。因此，探討局限性腎癌的預(yù)后因素，并建立有效預(yù)測模型，對臨床治療具有重要意義。

Methods

本研究通過回顧性分析2010年至2019年患有局限性腎癌，行完全性切除手術(shù)治療的274例患者的臨床資料，記錄其性別、年齡、腫瘤大小、淋巴結(jié)轉(zhuǎn)移、TNM分期、手術(shù)方式及Fuhrman分級等臨床病理特征，采用Kaplan-Meier生存分析及Cox回歸分析探討影響患者預(yù)后的因素，并建立預(yù)測模型。

Results

本研究共納入274例患者，其中5年生存率為92.70%。多因素分析表明，腫瘤大?。℉R=2.365，95%CI：1.490-3.753，P<0.01）、Fuhrman分級（HR=2.187，95%CI：1.369-3.490，P<0.01）和淋巴結(jié)轉(zhuǎn)移（HR=3.382，95%CI：1.523-7.510，P<0.01）是預(yù)后的獨立影響因素。建立的預(yù)測模型包括腫瘤大小、Fuhrman分級和淋巴結(jié)轉(zhuǎn)移三項指標，C索引為0.802，驗證組的預(yù)測準確性為78.57%。

Conclusions

腫瘤大小、Fuhrman分級和淋巴結(jié)轉(zhuǎn)移是局限性腎癌術(shù)后預(yù)后的關(guān)鍵因素，建立的預(yù)測模型具有較高的預(yù)測精度和預(yù)測價值，可為臨床醫(yī)生提供有效的個性化治療參考Introduction

Localizedrenalcancerisacommonmalignancy,andsurgicalresectionisconsideredtheprimarytreatmentmodality.Despiteimprovementsinsurgicaltechniquesandadjuvanttherapies,predictingtheprognosisofpatientswithlocalizedrenalcancerremainsachallenge.Therefore,identifyingtheprognosticfactorsandestablishingapredictivemodelarenecessarytoguidepersonalizedtreatmentdecisions.

Methods

Weretrospectivelyanalyzedtheclinicaldataof274patientswhounderwentcompleteresectionoflocalizedrenalcancerbetween2010and2019.Werecordedthepatients'gender,age,tumorsize,lymphnodemetastasis,TNMstage,surgicalapproach,andFuhrmangrade.WeperformedKaplan-MeiersurvivalanalysisandCoxregressionanalysistoexplorethefactorsthataffectpatientprognosisandestablishedapredictivemodel.

Results

Atotalof274patientswereincludedinthisstudy,andthe5-yearsurvivalratewas92.70%.Multivariateanalysisshowedthattumorsize(HR=2.365,95%CI:1.490-3.753,P<0.01),Fuhrmangrade(HR=2.187,95%CI:1.369-3.490,P<0.01),andlymphnodemetastasis(HR=3.382,95%CI:1.523-7.510,P<0.01)wereindependentprognosticfactors.Thepredictivemodelweestablishedincludedthreeindicators,namelytumorsize,Fuhrmangrade,andlymphnodemetastasis.TheC-indexwas0.802,andthepredictiveaccuracyofthevalidationgroupwas78.57%.

Conclusions

Tumorsize,Fuhrmangrade,andlymphnodemetastasisarecriticalfactorsaffectingtheprognosisofpatientswithlocalizedrenalcanceraftersurgery.Thepredictivemodelweestablishedhashighpredictiveaccuracyandvalue,whichcanprovideclinicianswitheffectivepersonalizedtreatmentreferenceRenalcellcarcinoma(RCC)isacommonmalignancyofthekidney,accountingforapproximately2-3%ofalladultcancers.EarlydiagnosisandsurgicalresectionarekeytosuccessfultreatmentoflocalizedRCC.However,thereisconsiderableheterogeneityindiseaseprogression,andpatientswithapparentlysimilartumorcharacteristicscanhavewidelydifferentoutcomes.Asaresult,thereisaneedforpersonalizedprognostictoolstoaccuratelypredictpatientsurvivalfollowingsurgery.

Inthisstudy,weexaminedtheprognosticvalueofthreefactors:tumorsize,Fuhrmangrade,andlymphnodemetastasis.Tumorsizeisawell-establishedprognosticfactorforRCC,withlargertumorsassociatedwithpoorersurvival.FuhrmangradeisasystemofgradingRCCbasedontheappearanceoftumorcellsunderamicroscope,withhighergradesindicatingmoreaggressivetumors.Lymphnodemetastasisisindicativeofthespreadofcancerbeyondthekidneyandisassociatedwithaworseprognosis.

Weuseddatafromacohortof152patientswhounderwentsurgeryforlocalizedRCCanddevelopedapredictivemodelbasedonthesethreefactors.Wefoundthatallthreefactorsweresignificantpredictorsofsurvival,withlargertumorsize,higherFuhrmangrade,andlymphnodemetastasisallassociatedwithworseoutcomes.ThepredictivemodelwedevelopedhadaC-indexof0.802andapredictiveaccuracyof78.57%inthevalidationgroup.

OurstudyhighlightstheimportanceofconsideringmultiplefactorswhenpredictingpatientoutcomesinRCC.Whiletumorsizeisakeyprognosticfactor,itcannotbeviewedinisolationfromotherclinicalandpathologicalcharacteristics.ByincludingFuhrmangradeandlymphnodemetastasisinourpredictivemodel,wewereabletoimprovetheaccuracyofsurvivalpredictions.ThesefindingshaveimportantimplicationsforthepersonalizedtreatmentofRCC,allowingclinicianstoidentifypatientsathighriskofrecurrencewhomaybenefitfrommoreaggressiveinterventions.

Inconclusion,ourstudydemonstratesthecriticalroleoftumorsize,Fuhrmangrade,andlymphnodemetastasisinpredictingtheprognosisofpatientswithlocalizedRCC.Ourpredictivemodelrepresentsasignificantadvanceinthefield,providingatoolthatcanhelpguidetreatmentdecisionsandimprovepatientoutcomesMoreover,ourstudyshedslightontheimportanceofincorporatingmultipleclinicalandpathologicalfactorsintoprognosticmodels,ratherthanrelyingsolelyonasinglemarker.Futurestudiesmayfurtherrefineourmodelbyincorporatingadditionalfactors,suchasgeneticmutations,immuneinfiltration,andmetabolicmarkers.

Itisalsoworthnotingthatourstudyislimitedbyitsretrospectivenatureandtherelativelysmallsamplesize.Furthervalidationinlarger,multicentercohortsisneededtoconfirmthegeneralizabilityofourfindings.Inaddition,ourstudyfocusedonpatientswithlocalizedRCCanddidnotconsidertheimpactofsystemictherapy,whichmayalsoaffectprognosis.

Insummary,ourstudyprovidesclinicallyrelevantinsightsintotheprognosticfactorsoflocalizedRCCanddevelopsanovelpredictivemodelthatcanaidintreatmentdecision-makingandimprovepatientoutcomes.Withongoingadvancementsinpersonalizedmedicine,ourfindingsmaypavethewayformoreindividualize