肾细胞癌的预后及随访肾细胞癌的预后及随访prognosis and surveillance of renal cell carcinoma Part 1: 预后因素1. 解剖学因素解剖学因素2. 组织病理学因素病理学因素3. 临床因素床因素4. 分子分子遗传学因素学因素5. 预后后预测系系统及量表及量表1. 解剖学因素T1aN0M0T1bN0M0T2aN0M0T2bN0M0T3aN0M0T3bN0M0T3cN0M0T4N0M0TxN1M0TxNxM11009080706050403020100Campbell-Walsh Urology; 10Th edition 2. 组织病理学因素（Grading System）G1G2G3G4100%90%80%70%60%50%40%30%20%10%0%64%34%31%10%5-yr Survival Rates(Fuhrman Grading System)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 tumorsZhang 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: 1309-13162. 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 femalesMultivariate 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, respectivelyRelative risks of radiation induced solid cancers and leukemia were 1.05 and 1.12, respectivelyLipsky MJ, Shapiro EY, Hruby GY, et al. Urol 2013; 80: 1190-1195.58 mRCC ptsMedian follow up 31.4mMedian PFS 12.4m (48pts with the best response SD)47 pts PD at the time of data cutoffPark 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！