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目的:肾癌伴淋巴结肿大患者是否行淋巴结清扫有很大争议,探索这类患者伴淋巴结转移的风险因素,以辅助临床决策。方法:回顾性分析2006年1月~2014年12月接受手术治疗且术前检查或术中探查发现淋巴结肿大的全部328例肾癌患者的临床及病理资料,分析年龄、发病症状、肿瘤最大径,pT分期,远处转移,Furhman核分级,肿瘤伴坏死、出血、肉瘤样结构及血管、集合系统、肾被膜受侵与淋巴结转移的关系。结果:在多自变量logistic回归分析中,年龄与肾癌伴淋巴结肿大患者肾根治性切除时淋巴结阳性负相关,远处转移、核分级、肾被膜受侵、pT分期与淋巴结阳性正相关。结论:患病年龄小、伴远处转移、核分级高、肾被膜受侵、pT分期高是肾癌伴淋巴结肿大患者手术时淋巴结阳性的高危因素。
OBJECTIVE: It is controversial whether lymph node dissection is performed in patients with renal cell carcinoma and lymphadenopathy. The risk factors for lymph node metastasis in these patients are explored to assist in clinical decision-making. Methods: The clinical and pathological data of 328 patients with renal cell carcinoma who underwent surgical treatment from January 2006 to December 2014 were retrospectively analyzed. Preoperative examination or intraoperative exploration revealed that lymph nodes were enlarged. The age, symptom and tumor size were analyzed Pathology, pT staging, distant metastasis, Furhman’s nuclear grade, tumor with necrosis, hemorrhage, sarcomatoid structure and vascular, collecting system, renal capsule invasion and lymph node metastasis. Results: In the multivariate logistic regression analysis, there was a negative correlation between age and lymph node metastasis in patients with renal cell carcinoma and lymph node enlargement. There was a positive correlation between distant metastasis, nuclear grade, renal capsule invasion and pT staging and lymph node positive. Conclusion: The younger the disease, the more distant metastasis, the higher the nuclear grade, the invasion of the renal capsule, the high stage of pT is a risk factor for lymph node-positive patients with renal cell carcinoma and lymphadenopathy.