3. 临床因素（ESR & Aneamia)
Multivariate analyses: Patients with high level ESR VS low levels: HR 2.10 (95% CI: 1.21–3.67)
ESR:>22mm per hour for males, >29mm per hour for females
Campbell-Walsh Urology; 10Th edition
2. 组织病理学因素 （Grading System）
5-yr Survival Rates(Fuhrman Grading System)
100%
organ-confined tumors
90%
80%
70%
64%
60%
50%
3.临床因素（age）
5yr CSS for the young and the old were 92% and 84%
5yr OS for the young and the oldwere 91% vs 77%
Aziz A, May M, Zigeuner R, et al. J Urol 2014; 191:310-315.
ccRCC were almost 4 times as likely to have progression to distant metastasis than papillary and chromophobe RCC (HR 3.82, 95% CI 2.86–5.11,P<0.001)
Zhang 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: 1309-1316
2. 组织病理学因素 (other factors)
ALL
M0
2,662Pts
Leibovich BC, Lohse CM, Crispen PL. et al. J Urol 2012; 183: 1309-1316
2. 组织病理学因素 (other factors)
ALL
M0
M1
Microvascular Invasion (CSS)
2. 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 2.59–4.18, p <0.001)
✓这些标记物并未改善当前预后分析系统的预测精 确性
✓这些标记物无助于发现新的临床预测因子
5. 预后预测系统及量表
Flanigan RC, Polcari AJ, Hugen CM. Int J Urol 2011; 18: 20-31.
Kattan (61-81%)
UISS (81%)
SSIGN (81-88%)
Kroeger N, Rampersaud EN, Patard J,et al. J Urol 2012; 187:418-423
3. 临床因素
• 体能状况 • 症状 • 恶液质样症状
• 年龄 • 贫血 • ESR
Leibovich BC, Lohse CM, Crispen PL. et al. J Urol 2012; 183: 1309-1316
术后随访的目的是 什么？
新发病灶预示局部疾 病还是系统性疾病？
针对该病灶有无有效 治疗方式？
早发现早治疗是否能 否使患者生存获益？
Risk stratification
UISS EAU guideline
• I 期(T1N0M0)
项目（年）
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 2. 组织病理学因素 3. 临床因素 4. 分子遗传学因素 5. 预后预测系统及量表
1. 解剖学因素
100 90 80 70 60 50 40 30 20 10 0
5-yr CSS Patients with anaemia VS patients without, the HR (95% CIs) was 2.01 (1.22–3.29)
Cutoff : Hb:<13.5 g dl-1 for males, <12 g dl-1 for females; Hct:<41% for males, <36% for females
40%
34%
31%
302
G3
G4
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.
Choi Y, Park B, Kim K, et al. Br J Ca 2013; 108: 387-394. Choi Y, Park B, Kim K, et al. Br J Ca 2013; 108: 387-394
4.分子遗传学因素
• Carbonic anhydrase IX (CaIX), VEGF, HIF, • Ki67 (proliferation), p53, PTEN (cell cycle), • E-cadherin, CRP, and CD44 (cell adhesion)
Karakiewicz (89%)
5. 预后预测系统及量表
Karakiewicz et al. J. Clin. Oncol. 2007; 25: 1316
5. 预后预测系统及量表
PART 2: 随访
时间间隔 检查内容
➢术后并发症 ➢肾脏功能
➢术后复发 ➢远处转移
Cost-Effectiveness