肾癌预后ppt课件

BasicParametersofBloodCountasPrognosticFactorsforRenalCellCarcinoma 研究血常规参数做为肾癌的预后因素 1 研究方法 Thestudywasretrospectiveandusedthemedicalrecordsof397patientswhounderwentsurgeryforkidneytumorsinourcenterintheyears2000 2006 Duringthefive yearfollow upperiodofall397patientsoperatedon 230patientswiththepostoperativediagnosisofnonmetastaticrenalcellcarcinomawereenrolledinthestudy 利用统计学的方法分析血液参数 肿瘤大小 分级 部位等与肾癌预后 复发 转移及死亡之间的关系 2 研究结果 Thestudygroupincluded123menand107women Theaverageagewas60 9 10 5years Tumorsizewas6 8 4 1cm 89patientsunderwentnephronsparingsurgery NSS meantumorsizewas4 16cm and141patientsunderwentradicalnephrectomy meantumorsizewas7 9cm Localrecurrenceduringfollow upoccurredin25patients 10 8 anddistantmetastaseswerefoundin22patients 9 5 Tumor specificdeathwasreportedin6casesaftertheNSS 2 6 andin43 18 6 afterradicalnephrectomy Therewasanalmostidenticaldistributionofneoplasticchanges takingintoaccountthesideoperatedon 113intherightand117intheleftkidney Wealsoevaluatedtheanatomicallocationofthetumor Themostfrequentlyobservedtumorswerelocatedonthedorsalsideofthekidney followedbythelowerandupperpole Inthecentralpartofthekidney 7tumorsweredetected Figure1 3 4 Thelowestclinicalstage T1 wasobservedin112patients T1a 48 T1b 64 T2in60patients T2a 33 T2b 27 andT3in54patients T3a 50 T3b 4 andthemostadvancedtypeofcancer T4 wasfoundin4patients HistologicalsubtypesofRCCintheexaminedgrouparepresentedinFigure2 AveragevaluesoftheanalyzedbloodparametersarepresentedinTable1 Averagevaluesoftheanalyzedbloodparameters 5 Fordeterminingtheriskofmetastasis tumorrecurrence ordeath Coxproportionalhazardsmodelwasused Inthisstatisticalregression completeandcensoreddataweretakenintoaccount Relatively thehighestnumberofmedical physical chemical andbiologicalriskfactorsisassignedinthisanalysistopatients death followedbytumorrecurrenceandmetastasis Statisticallysignificantresults p 0 05 intheunivariatemodelaresummarizedinTable2 Intermsoftheimpactofasingleriskfactor itcanbesaidthatthelocationofthetumorhasastrongstatisticalrelationshipwiththeoccurrenceofmetastasis Coxregressionresultsrelatingtothelocationofthetumorinthelower upper ordorsalpolecomparedtothecentrallocationareassociatedwithasignificantdecreaseintheriskofmetastasis respectively 1 0 096 100 90 1 0 084 100 91 6 and 1 0 174 100 82 Itwasalsoobservedthatthedeclineinthevalueofthestudiedbloodcountparameterswiththeexceptionofplateletcount PLT andMPVisanunfavorableprognosticfactor p 0 05 TheresultsofthemultivariateCoxregressionaresummarizedinTable3 Basedonthisanalysis factorscorrelatedwithmetastasishavenotbeenfound Inthisanalysis asinthelogisticregression lowpredictivevalueofsinglebloodparameterswasrevealed ChartsofproportionalsurvivalratesofpatientsaccordingtothenumberofplateletsarepresentedinFigure3 6 7 8 9 InaCoxmultivariateanalysis asinthelogisticregression lowpredictivevalueofindividualmorphologyparameterswasrevealed GraphsofproportionalsurvivaldependingonthenumberandvolumeoftheplateletsareshowninFigures 3and 4平均血小板体积 10 Afteranalyzingthequalityofclassifiers suspectedriskfactors intherangeofanalyzedtraitsusingtheROCcurve therewasnostatisticallysignificantfactordeterminingtheincreasedriskofmetastasisinpatients Thenumberofstatisticallysignificantclassifiersdefiningtheoccurrenceofrelapseanddeathisroughlythesame Themostlikelyeventispredictingthecaseoftumorrecurrenceusingtheplateletcount PLT Forthecut offpointof243 5plateletunits specificity59 sensitivity88 thelikelihoodofcorrectlypredictinganeventisupto80 AUC Figure5 Inthecaseoftumorsize cut offpointof7 5cm HGB cut offpointof11 6g dL MCV cut offpointof86 0fL andMCH 30 2pgcut offpoint thelikelihoodofcorrectlypredictingrecurrencewithinfiveyearsoffollow upwas64 68 73 and67 respectively Asimilaranalysisofpotentialpredictivefactorsfordeathwascarriedout Inthiscase wehavea68 likelihoodofoccurrencewithacut offpointat7 5cm specificity78 9 sensitivity49 Thebestindicatorinthiscaseappearstobetheplateletcount Theprobabilityofdeathwithinaspecificfive yearfollow upwas77 7 atacut offpointat351thousand L Thespecificityandsensitivityofthisclassifierare95 3 and55 1 Figure6 TheworstindicatorintermsofpredictingmortalityisMCH thelikelihoodofpredictingthecorrecteventusingthismarkerislessthan64 ataspecificityandsensitivityof77 and53 11 12 结论 1 Lowpreoperativehemoglobinconcentration hematocrit averageweightofhemoglobin meanvolume andmeanhemoglobinconcentrationmaybeconsideredinthecategoryofriskfactorsforrecurrenceandprogressionofrenalcellcarcinomaaftersurgicaltreatment 2 Thebestpredictoramongtheanalyzedpreoperativelaboratoryparametersistheplateletcountandvolume 3 Preoperativeplateletcountabove243 5thousand uLand351thousand uL respectively isanindependentpredictorofrecurrenceandtumor specificdeathduringthefiveyearsoffollow up 4 Preoperativeaveragesizeofplateletslessthan10 1fLisanindependentpredictoroftumor specificmortalityduringthefive yearfollow up 1 术前低血红蛋白浓度 红细胞压积 平均血红蛋白体积 平均血红蛋白含量 平均血红蛋白浓度可能是肾细胞癌手术治疗后的复发和进展的危险因素 2 分析术前实验室参数血小板计数和体积是最佳预测因子 3 在五年的随访中术前血小板计数高于24万3500 UL35万1000 ul 分别是肿瘤复发和肿瘤特异性死亡率的独立预测因素 4 在5年的随访中术前血小板平均体积小于10 1FL是肿瘤特异性死亡率的独立预测因子 13 Discussion Numerousreportsoftreatmentoferythropoietin EPO levelelevationinpatientswithrenalcancerpromptedustosearchthepotentialprognosticfactorsamongbloodcounts ManystudieshaveconfirmedtheoverexpressionofEPOanditsreceptor EPOR inclearcellrenalcarcinoma Theprognosticvalueofthisfindingmeritsfurtherinvestigation IfEPOlevelelevationisobservedinpatientswithrenalcellcancer itwouldappearthatweshouldwatchforpolycythemiainthesepatients Clinicalpracticehoweverdemonstratesthatthisisnotinfactthecase DespitetheincreaseintheexpressionofEPOandEPOR inupto35 ofpatientswithRCC anemiaisobservedandonly1 5 ofpatientsdevelopparaneoplasticpolycythemia 14 Whythishappensisnotentirelyclear AttemptsforexplanationincludetheweakactivityofEPOproducedbythetumorandthelowsensitivitytothisfactorofthetissuesinvolvedintheproductionofblood Thelowlevelandabnormalironmetabolismmayplayanimportantrole Thebreakdownoftumorcellsinthemicrovesselshasalsobeendescribed Growthofinflammatoryfactorsandantibodiesthatoccursduringcarcinogenesismaycontributetoautoimmunehemolysis Amongthepreoperativeparametersassociatedwiththeredbloodcellssystem theerythrocytecount hemoglobin hematocrit meancorpuscularvolume meancorpuscularhemoglobinconcentration therateoftheaverageweightofcorpuscularhemoglobin andthecoefficientofvariationofvolumedistributionoferythrocytes anisocytosis wereanalyzedinthestudy Ithasbeenproventhatloweringthevalueofalltheabove mentionedparametersexceptanisocytosisbelowaspecifiedcut offpointresultsinanincreasedriskoftumor specificdeathwithinthefiveyearsoffollowup ReducedpreoperativevaluesofHGB HCT MCV andMCHalsopredisposepatientstoearlyrecurrenceofcancer Similarresultswerealsoobtainedbyotherauthors 21 24 15 血小板增多症在肾细胞癌预后评估中的价值 外周血血小板增高对肾细胞癌的预后意义 恶性肿瘤患者血小板增多的临床意义 术前血小板计数与结直肠癌患者预后的关系 妇科恶性肿瘤与血小板增多的关系 目前血小板对恶性肿瘤预后影响机制的研究主要集中在促进肿瘤生长和转移两个方面 Kuo等报道血小板激活后释放多种促有丝分裂的活化因子 这些因子可直接刺激肿瘤细胞生长 Kirwan等研究表明活化的血小板可促进VEGF的释放 从而促进肿瘤血管生成利于肿瘤生长 Ho Tin No 等报道血小板可防止炎症诱导的血管损伤 从而防止肿瘤内出血利于肿瘤生长 另有Jurasz等研究显示血小板可使循环中肿瘤细胞逃避机体免疫系统的攻击 还可保护肿瘤细胞免受血流高剪应力的损害 McCarty等研究证实血小板参与肿瘤细胞对血管内皮细胞的黏附 Cohen等报道血小板聚集导致血管内皮细胞收缩 从而利于肿瘤向血管外移行 16 谢谢 17