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【Objective】 To evaluate the clinical characteristics and survival of patients with rare clear cell papillary renal cell carcinoma (ccpRCC). 【Methods】 Clinical data of ccpRCC cases treated during 2016 and 2019 were analyzed, clinical characteristics were described, and survival was analyzed using the Kaplan-Meier method. 【Results】 In the SEER database, 191 ccpRCC cases with complete clinical data and positive histology were retrieved, including 112 males (58.7%) and 79 females (41.3%), 136 Grade 1-2 (71.2%) cases and 19 Grade 3-4 (10.0%) cases, 174 stage T1 (91.1%) cases and 17 stage T2-3 (8.9%) cases. Distant metastasis (lung metastasis combined with lymph node involvement and major vein involvement) occurred in one case, and vein tumor thrombosis occurred in two patients. Surgery especially radical nephrectomy and partial nephrectomy was performed in 181 patients (94.8%). One patient died due to recurrence, and 4 due to other causes. The 12-month and 24-month survival were 98.5% and 97.4%, respectively. 【Conclusion】 Patients with ccpRCC have low clinical stage and histological grade, minimal tumor progression and distant metastasis, good prognosis and extremely low disease-specific mortality. Radical nephrectomy and partial nephrectomy have significant therapeutic effects.
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Objective:To construct an effective survival nomogram for patients with clear cell renal cell carcinoma (ccRCC) using a large sample sized Chinese dataset, which can be used to predict individual 3- and 5-year overall survival (OS) precisely.Methods:The data of 672 ccRCC patients received operation diagnosed at Xijing Hospital from January 2012 to December 2016 were retrospectively analyzed. There were 467 males and 205 females. Their median age was 56 years old (ranging 23-83 years old). There were 327 patients with tumor on the left kidney and 345 patients with tumor on the right kidney. Clinical stageⅠ, Ⅱ, Ⅲ, Ⅳ were 584, 47, 19 and 22 cases, respectively. At the time of diagnosis, 504 patients were asymptomatic and 168 patients were symptomatic. Preoperative alkaline phosphatase was 80 (41-240) U/L. Preoperative serum albumin was 44.8 (30.5-59.8) g/L. Preoperative neutrophil absolute value/lymphocyte absolute value (NLR) was 2.25 (0.81-9.89). Preoperative platelet count was 205 (82-589)×10 9/L. Preoperative creatinine was 97 (55-230) μmol/L. Radical nephrectomy was performed in 420 (62.5%) patients and partial nephrectomy was performed in 252 patients. Cox multivariate analysis was used to determine the independent predictors of the postoperative OS. Then, the nomogram was constructed using R software, which integrates all independent predictors according to the coefficients in the multivariate analysis. Moreover, the performance of the nomogram was evaluated using the consistency index (C-index) and the calibration plots. Results:Cox multivariate analysis results showed that age at diagnosis ( P<0.001), clinical TNM stage ( P<0.001), preoperative NLR ( P=0.012), preoperative alkaline phosphatase ( P=0.002) and preoperative albumin ( P<0.001) were the independent predictors of postoperative OS in ccRCC patients. The nomogram established by integrating these five factors had a good discriminatory ability (C-index=0.819, 95% CI 0.813-0.825), and the calibration plots showed that excellent agreements between the nomogram prediction and the actual observation were achieved. Conclusions:Based on a large sample sized Chinese dataset, this study established an effective survival model for patients with ccRCC and good performance of the nomogram was demonstrated by internal validation. Our nomogram can help urologists to predict individual 3- and 5-year OS accurately for Chinese ccRCC patients.
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Objective@#To explore the independent predictors for recurrence-free survival (RFS) in patients with papillary renal cell carcinoma (PRCC), and establish a nomogram to predict individual 2-year RFS.@*Methods@#The data of patients diagnosed in Xijing Hospital of the Air Force Medical University from June 2009 to May 2018 were retrospectively analyzed. A total of 71 patients with primary T1-4N0M0 unilateral tumor were included in this study. The median age was 54 (range from 25 to 83) years. There were 51 males and 20 females. There were 27 cases of typeⅠ, 44 cases of type Ⅱ, 36 cases of left tumor and 35 cases of right tumor. Patients with clinical Ⅰ, Ⅱ, Ⅲ, Ⅳ stage were 47 cases, 12 cases, 9 cases and 3 cases, respectively. Tumor necrosis occurred in 15 cases (21.1%). The average preoperative alkaline phosphatase (ALP) was 89.0(43.0-217.0) U/L, the average preoperative hemoglobin (Hb) was (132.5±19.9) g/L, with 20 cases (28.2%) of Hb<120 g/L before surgery; the average of preoperative Hb was (132.5±19.9) g/L, among which 20 cases (28.2%) had Hb<120 g/L before surgery; the average of preoperative neutrophils/lymphocytes (NLR) was 2.40 (1.03-6.77); radical nephrectomy was performed in 43 patients and nephrectomy was performed in 28 patients. The 1-, 2-, and 3-year RFS were calculated using Kaplan-Meier method and the differences among different subgroups were assessed using Log-rank test. Univariate and multivariate Cox regression analysis were used to identify the independent predictors for RFS, and the nomogram was developed using R software according to the results of multivariate Cox regression analysis. Furthermore, the predictive ability of the nomogram was internally validated using the Bootstrap method by calculating the C-index and drawing the calibration plot.@*Results@#After a median follow-up of 41 ( range from 25 to 83) months, 16 (22.5%) recurrence occurred, including 4 local recurrence and 12 distant recurrence, and 11 (68.8%) patients relapsed within 2 years after surgery. The 1, 2, and 3-year RFS were 88.6%, 80.4%, and 78.7%, respectively. Clinical stage Ⅱ (HR=3.655, 95%CI 1.036-12.890, P=0.044) and stage ≥Ⅲ(HR=3.654, 95%CI 1.008-13.248, P=0.049), preoperative ALP≥90U/L(HR=3.274, 95%CI 1.044-10.267, P=0.042), preoperative Hb<120 g/L (HR=4.771, 95%CI 1.553-14.660, P=0.006), and preoperative NLR≥2.40(HR=4.701, 95%CI 1.238-17.849, P=0.023) were identified as independent risk factors for RFS. On internal validation, the nomogram which integrates the four predictors of clinical stage, preoperative ALP, preoperative HB and preoperative NLR, has a good predictive performance (C-index =0.829, 95%CI 0.819-0.839).@*Conclusions@#In the present study based on single center data, clinical stage Ⅱ and ≥Ⅲ, preoperative ALP≥90 U/L, preoperative Hb<120 g/L and preoperative NLR ≥2.40 were independent predictors for postoperative RFS in patients with PRCC, and a new preoperative nomogram for predicting individual postoperative 2-year RFS was established, which would be helpful for urologists to develop more systematic treatment plans.
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Objective To explore the independent predictors for recurrence-free survival (RFS) in patients with papillary renal cell carcinoma (PRCC),and establish a nomogram to predict individual 2-year RFS.Methods The data of patients diagnosed in Xijing Hospital of the Air Force Medical University from June 2009 to May 2018 were retrospectively analyzed.A total of 71 patients with primary T1-4 N0M0 unilateral tumor were included in this study.The median age was 54 (range from 25 to 83) years.There were 51 males and 20 females.There were 27 cases of type Ⅰ,44 cases of type Ⅱ,36 cases of left tumor and 35 cases of right tumor.Patients with clinical Ⅰ,Ⅱ,Ⅲ,Ⅳ stage were 47 cases,12 cases,9 cases and 3 cases,respectively.Tumor necrosis occurred in 15 cases (21.1％).The average preoperative alkaline phosphatase (ALP) was 89.0(43.0-217.0) U/L,the average preoperative hemoglobin (Hb)was (132.5 ± 19.9) g/L,with 20 cases (28.2％) of Hb ＜ 120 g/L before surgery;the average of preoperative Hb was (132.5 ± 19.9) g/L,among which 20 cases (28.2％) had Hb ＜ 120 g/L before surgery;the average of preoperative neutrophils/lymphocytes (NLR) was 2.40 (1.03-6.77);radical nephrectomy was performed in 43 patients and nephrectomy was performed in 28 patients.The 1-,2-,and 3-year RFS were calculated using Kaplan-Meier method and the differences among different subgroups were assessed using Log-rank test.Univariate and multivariate Cox regression analysis were used to identify the independent predictors for RFS,and the nomogram was developed using R software according to the results of multivariate Cox regression analysis.Furthermore,the predictive ability of the nomogram was internally validated using the Bootstrap method by calculating the C-index and drawing the calibration plot.Results After a median follow-up of 41 (range from 25 to 83) months,16 (22.5 ％) recurrence occurred,including 4 local recurrence and 12 distant recurrence,and 11 (68.8％) patients relapsed within 2 years after surgery.The 1,2,and 3-year RFS were 88.6％,80.4％,and 78.7％,respectively.Clinical stage Ⅱ (HR=3.655,95％CI 1.036-12.890,P =0.044) and stage ≥Ⅲ(HR =3.654,95％CI 1.008-13.248,P =0.049),preoperative ALP ≥ 90U/L (HR =3.274,95％ CI 1.044-10.267,P =0.042),preoperative Hb ＜ 120 g/L (HR =4.771,95％ CI 1.553-14.660,P =0.006),and preoperative NLR ≥2.40(HR =4.701,95％ CI 1.238-17.849,P =0.023) were identified as independent risk factors for RFS.On internal validation,the nomogram which integrates the four predictors of clinical stage,preoperative ALP,preoperative HB and preoperative NLR,has a good predictive performance (C-index =0.829,95％CI0.819-0.839).Conclusions In the present study based on single center data,clinical stage Ⅱ and ≥ Ⅲ,preoperative ALP≥90 U/L,preoperative Hb ＜ 120 g/L and preoperative NLR ≥2.40 were independent predictors for postoperative RFS in patients with PRCC,and a new preoperative nomogram for predicting individual postoperative 2-year RFS was established,which would be helpful for urologists to develop more systematic treatment plans.