肾癌预后及随访课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,2014/12/19 Friday,#,肾细胞癌的预后及随访,prognosis,and surveillance of renal cell carcinoma,张崔建,北京大学第一医院泌尿外科,北京大学泌尿外科研究所,Part 1:,预后因素,1.,解剖学因素,2.,组织病理学因素,3.,临床因素,4.,分子遗传学因素,5.,预后预测系统及量表,1.,解剖学因素,Campbell-Walsh Urology; 10,Th,edition,2.,组织病理学因素,（,G,rading,S,ystem,）,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 tumors,Zhang C, Li X, Hao H, et al.,BJU,International 2012; 110: E481-485,.,Leibovich BC, Lohse CM, Crispen PL. et al. J Urol,2012;,183: 1309-1316,2.,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 times 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 females,Multivariate analyses,: Patients,with high,level,ESR VS,low levels: HR 2.10,(95%,CI: 1.213.67,),5-yr CSS Patients,with anaemia,VS,patients 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,respectively,Lipsky MJ, Shapiro EY, 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 cutoff,Park 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！,