肾癌预后及随访课件.pptx

1、肾细胞癌的预后及随访肾细胞癌的预后及随访prognosis and surveillance of renal cell carcinoma Part 1: 预后因素1. 解剖学因素解剖学因素2. 组织病理学因素组织病理学因素3. 临床因素临床因素4. 分子遗传学因素分子遗传学因素5. 预后预测系统及量表预后预测系统及量表1. 解剖学因素0102030405060708090100T1aN0M0T1bN0M0T2aN0M0T2bN0M0T3aN0M0T3bN0M0T3cN0M0T4N0M0TxN1M0TxNxM1Campbell-Walsh Urology; 10Th edition 2. 组

2、织病理学因素（Grading System）64%34%31%10%0%10%20%30%40%50%60%70%80%90%100%G1G2G3G45-yr Survival Rates(Fuhrman Grading System)Fuhrman SA, Lasky LC, Limas C. Prognostic significance of morphologic parameters in renal cell carcinoma. Am J Surg Pathol 1982 Oct;6(7):655-63.organ-confined tumorsZhang C, Li X, Ha

3、o H, et al. BJU International 2012; 110: E481-485.Leibovich BC, Lohse CM, Crispen PL. et al. J Urol 2012; 183: 1309-13162. 组织病理学因素 (Subtype)ccRCC were more than 3 times as likely to die of RCC than patients with papillary and chromophobe RCC(HR 3.29, 95% CI 2.594.18, p 0.001)ccRCC were almost 4 time

4、s as likely to have progression to distant metastasis than papillary and chromophobe RCC (HR 3.82, 95% CI 2.865.11,P22mm per hour for males, 29mm per hour for femalesMultivariate analyses: Patients with high level ESR VS low levels: HR 2.10 (95% CI: 1.213.67) 5-yr CSS Patients with anaemia VS patien

5、ts without, the HR (95% CIs) was 2.01 (1.223.29)Cutoff : Hb:13.5 g dl-1 for males, 12 g dl-1 for females; Hct:41% for males, 6 after surgery were 11.4, 47.0, and 13.8 mSv, respectively Relative risks of radiation induced solid cancers and leukemia were 1.05 and 1.12, respectivelyLipsky MJ, Shapiro E

6、Y, Hruby GY, et al. Urol 2013; 80: 1190-1195. 58 mRCC pts Median follow up 31.4m Median PFS 12.4m (48pts with the best response SD) 47 pts PD at the time of data cutoffPark I, Lee J, Ahn JH, et al. J cancer Res Clin Oncol 2014; 140: 1421-1428 是否一旦出现转移就需立刻治疗？小结 TNM分期、Fuhrman分级、病理亚型是最重要的预后影响因素 坏死、肉瘤样分化、微血管侵犯等病理特征也是预后的影响因素 当前何种随访策略更为有效尚无定论 应根据肿瘤风险分级，实现个体化随访 应兼顾费用-效益比及放射性损害谢 谢！