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目的探讨术前外周血血小板计数对肾透明细胞癌(CCRCC)预后的意义。方法回顾性分析初诊并术后病理证实的292例CCRCC患者的临床资料及随访情况,以患者血小板计数300×109/L为界值将患者分为正常和增高两组,应用Kaplan-Meier法进行生存分析并行Log-rank检验,Cox比例风险模型分析血小板增高及其他临床因素对患者总生存(OS)和无进展生存(PFS)预后的影响。结果该研究CCRCC患者中血小板增高发生率为9.59%(28/292),正常组1年、3年、5年的总生存率和无进展生存率分别为100%、99%、97%和99%、97%、86%,而增高组分别为89%、84%、84%和86%、81%、81%,两组OS(χ2=13.023,P=0.000)和PFS(χ2=3.968,P=0.046)比较有统计学意义。单因素分析显示,发病方式、肿瘤大小、肿瘤坏死情况、病理分级、T分期、TNM分期是OS的预后因素,而且肿瘤大小和TNM分期还是PFS的预后因素。多因素分析显示,病理T分期和TNM分期是PFS预后的独立因素,血小板计数是OS预后的独立因素。结论术前外周血血小板增高是CCRCC预后不良的独立预后因素。
Objective To investigate the significance of preoperative peripheral blood platelet count on the prognosis of renal clear cell carcinoma (CCRCC). Methods The clinical data and follow-up of 292 patients with newly diagnosed CCRCC confirmed by pathology were retrospectively analyzed. The patients were divided into two groups according to the platelet count of 300 × 109 / L. The patients were treated with Kaplan-Meier method Survival analysis Log-rank test and Cox proportional hazards model were used to analyze the effect of thrombocytopenia and other clinical factors on the prognosis of patients with OS and PFS. Results The overall incidence of thrombocytopenia was 9.59% (28/292) in CCRCC patients. The overall survival and progression-free survival at 1 year, 3 years and 5 years in normal group were 100%, 99%, 97% and 99%, respectively %, 97% and 86% in the two groups, while those in the high group were 89%, 84%, 84% and 86%, 81% and 81% P = 0.046) was statistically significant. Univariate analysis showed that morbidity, tumor size, tumor necrosis, pathological grade, T stage and TNM stage were prognostic factors of OS, and tumor size and TNM stage were also prognostic factors of PFS. Multivariate analysis showed that pathological T stage and TNM stage were independent prognostic factors of PFS. Platelet count was an independent prognostic factor in OS. Conclusion Preoperative peripheral blood platelet elevation is an independent prognostic factor for poor prognosis of CCRCC.