Prognostic factors of renal cell carcinoma patients undergone retroperitoneal laparoscopic partial nephrectomy

Abstract

Objective To explore the factors influencing the prognosis of patients with renal cell carcinoma after laparoscopic partial nephrectomy. Methods Clinical data from 593 renal cell carcinoma patients underwent laparoscopic partial nephrectomy in our institution from December 2010 to December 2015 were retrospectively collected.. There were 396 males and 197 females, aged 35 to 72 years old(mean 55.4 years). There were 181cases of smoking history, 206 cases of hypertension and 105 cases of diabetes. Before operation, 98 cases of liver function were damaged and 122 cases were anemia. There were 521 cases with PLT < 450×109/L, 72 cases PLT≥ 450×109/L. The tumor of 292 cases on the left and 301 cases on the right. The Kaplan-Meier method log-rank test was used for survival analysis. Univariate analysis and factors which were significantly associated with survival in the univariate analysis were conducted into the multivariate analysis with Cox proportional hazards model. Results The operative time was 88.0-120.6 min, mean 104.3 min, the blood loss during operation was 47.2-157.8 ml, mean 102.5 ml. Pathological tumor stage revealed that 398 cases were T1 and 195 cases were T2. Fuhrman classification revealed that 29 cases were gradeⅠ, 411 cases were gradeⅡ, 150 cases grade Ⅲ, 3 cases grade Ⅳ. The median follow-up time was 36 months(ranged 6 to 99 months). Five cases(1.3%)in the T1 patients relapsed, recurrence-free survival (RFS) rate was 98.7%; In the T2 patients, 7 cases (3.6%) relapsed, 1 of them had local recurrence and died of lung metastasis, and the RFS rate was 96.4%. Univariate analysis revealed that T stage, Fuhrman grade, tumor necrosis, tumor pseudocapsule, lymphovascular invasion, collection system violation, anemia, and high platelet were significantly associated with RFS of patients. Multivariate analysis found that T stage(HR=1.524, 95%CI 1.326-1.926, P=0.001), Fuhrman grade(HR=1.600, 95%CI 1.035-2.364, P=0.022), tumor necrosis(HR=2.315, 95%CI 1.523-3.624, P=0.001)were independent risk factors for the RFS of patients with renal cell carcinoma after retroperitoneal laparoscopic partial nephrectomy. Conclusion High T stage, high Fuhrman grade and tumor necrosis were independent risk factors for the RFS of patients with renal cell carcinoma after retroperitoneal laparoscopic partial nephrectomy. Key words: Renal cell carcinoma; Partial nephrectomy; Clinical efficacy; Prognosis