围手术期感染对肾细胞癌切除术后肿瘤特异性生存期的影响

doi:10.11904/j.issn.1002-3070.2020.02.015

摘要/Abstract

摘要： 目的探讨围手术期感染对肾细胞癌切除术后肿瘤特异性生存期(CSS)的影响。方法以青岛大学附属医院2006年1月—2013年1月收治的1 800例肾癌患者为研究对象,分析肾癌切除术后30 d内发生感染的情况。用Kaplan-Meier曲线分析感染与未感染患者的CSS;建立Cox比例风险模型来评估感染对CSS的影响时控制性别、年龄、AJCC分期和分级、肿瘤大小、病理学类型、合并症、手术方式和系统治疗等因素。结果 1 800例患者中位年龄74岁(69~79岁),中位随访时间为42个月(22~67月)。严重感染者141例,非严重感染者296例,未感染者1 363例。Kaplan-Meier分析结果显示,严重感染有改善肾癌(肿瘤直径为7.0~9.9 cm)患者CSS趋势(P=0.048);对于肿瘤直径≥10 cm或＜7 cm的患者,严重感染对CSS无影响(0.1~3.9 cm,P=0.120;4.0~6.9 cm,P=0.768;≥10 cm,P=0.412)。多因素Cox回归分析结果显示,严重感染可以改善肾癌患者的CSS(HR=0.752,P=0.032)。这种效应在肿瘤直径≥7 cm的患者中较为明显(P=0.041),而在肿瘤直径＜7 cm的患者中表现得不明显(P=0.268)。结论围手术期严重感染可以改善肿瘤直径7~10 cm的肾癌患者CSS,但是对肿瘤直径≥10 cm或＜7 cm肾癌患者的CSS无明显影响。

关键词: 感染, 肾细胞癌, 肾癌切除术, 肿瘤特异性生存率

Abstract: Objective The aim of this study was to investigate the effect of perioperative infection on cancer specific survival(CSS)after renal cell carcinoma resection.Methods A total of 1 800 patients with renal cell carcinoma from January 2006 to January 2013 in the Affiliated Hospital of Qingdao University were used as the research subjects,and the infection situation within 30 days after nephrectomy for renal cancer was analyzed.The CSS of infected and uninfected patients was analyzed by Kaplan-Meier curve,and Cox proportional hazard model was established to evaluate CSS.The factors such as sex,age,AJCC stage and classification,tumor size,pathological type,complications,surgical methods and systematic treatment were also controlled.Results The median age of 1 800 patients was 74 years(69~79 months),and the median follow-up time was 42 months(22~67 months).There were 141 cases of severe infection,296 cases of non-severe infection and 1 363 cases of non-infection.Kaplan-Meier analysis showed that severe infection had a tendency to improve CSS in patients with renal cancer(tumor diameter 7.0~9.9)(P=0.048),but severe infected patients with tumor diameter ≥10 cm or ＜7 cm had no effect on CSS(0.1~3.9 cm,P=0.120;4.0~6.9 cm,P=0.768;＞10 cm,P=0.412).Multivariate Cox regression analysis showed that severe infection could improve CSS in patients with renal cancer(HR=0.752,P=0.032).This effect was more obvious in patients with a tumor diameter(＞7 cm)(P=0.041),but it was not in patients with tumor diameter ＜ 7 cm(P=0.268).Conclusion Severe perioperative infection can improve CSS in patients with renal cancer with a tumor diameter of 7~10 cm,but it has no effect on CSS in patients with tumors ≥10 cm or ＜7 cm in diameter.

Key words: Infection, Renal cell carcinoma, Renal cancer resection, Tumor-specific survival rate

中图分类号:

R737.11

韩雪阳, 李彬, 孙照勇, 王方明, 刘勇. 围手术期感染对肾细胞癌切除术后肿瘤特异性生存期的影响[J]. 实用肿瘤学杂志, 2020, 34(2): 169-175.

HAN Xueyang, LI Bin, SUN Zhaoyong, WANG Fangming, LIU Yong. Effect of perioperative infection on tumor-specific survival after nephrectomy for renal cell carcinoma[J]. Journal of Practical Oncology, 2020, 34(2): 169-175.

0
/ / 推荐

导出引用管理器 EndNote|Reference Manager|ProCite|BibTeX|RefWorks

链接本文: http://journal09.magtechjournal.com/Jwk3_syzlxzz/CN/10.11904/j.issn.1002-3070.2020.02.015

http://journal09.magtechjournal.com/Jwk3_syzlxzz/CN/Y2020/V34/I2/169

参考文献

1 Ferlay J,Steliarova-Foucher E,Lortet-Tieulent J,et al.Cancer incidence and mortality patterns in Europe:estimates for 40 countries in 2012[J].Eur J Cancer,2013,49(6):1374-1403.
2 Ljungberg B,Bensalah K,Canfield S,et al.EAU guidelines on renal cell carcinoma:2014 update[J].Eur Urol,2015,67(5):913-924.
3 Tannir NM,Pal SK,Atkins MB.Second-line treatment landscape for renal cell carcinoma:a comprehensive review[J].Oncologist,2018,23(5):540-555.
4 Hudachek SF,Kraft SL,Thamm DH,et al.Lung tumor development and spontaneous regression in lambs coinfected with Jaagsiekte sheep retrovirus and ovine lentivirus[J].Vet pathol,2010,47(1):148-162.
5 Sul·zyc-Bielicka V,Kołodziejczyk L,Jaczewska S,et al.Colorectal cancer and Cryptosporidium spp.infection[J].PLoS One,2018,13(1):e0195834.
6 Jeys LM,Grimer RJ,Carter SR,et al.Post operative infection and increased survival in osteosarcoma patients:are they associated?[J].Ann Surg Oncol,2007,14(10):2887-2895.
7 Yang L,Chen C,Li M,et al.Effects of anesthesia methods on insulin,blood glucose,immune and postoperative infection of gastric cancer patients complicated with diabetes mellitus[J].Minerva Endocrinol,2018,43(3):388-390.
8 Matsuo K,Prather CP,Ahn EH,et al.Significance of perioperative infection in survival of patients with ovarian cancer[J].Int J Gynecol Cancer,2012,22(2):245-253.
9 Nethala D,Wu WJ,Mistry PK,et al.Infected retroperitoneal fat necrosis after laparoscopic partial nephrectomy[J].Urol Case Rep,2018,17(1):103-105.
10 中华人民共和国卫生部.医院感染诊断标准[S].北京:中华人民共和国卫生部,2001:1-35.
11 Ng KL,Yap NY,Rajandram R,et al.Nuclear factor-kappa B subunits and their prognostic cancer-specific survival value in renal cell carcinoma patients[J].Pathology,2018,50(5):511-518.
12 Grunhagen DJ,de Wilt JH,Graveland WJ,et al.The palliative value of tumour necrosis alpha based isolated limb perfusion in patients with metastatic sarcoma and melanoma[J].Cancer,2006,106(1):156-162.
13 Hibbs JB Jr,Lambert LH Jr,Remington JS.Possible role of macrophage mediated nonspecific cytotoxicity in tumour resistance[J].Nat New Biol,1972,235:48-50.
14 Hibbs JB Jr.Infection and nitric oxide[J].J Infect Dis,2002,185:9-17.
15 Sánchez-Velázquez P,Pera M,Jiménez-Toscano M,et al.Postoperative intra-abdominal infection is an independent prognostic factor of disease-free survival and disease-specific survival in patients with stage II colon cancer[J].Clin Transl Oncol,2018,20(10):1321-1328.
16 Ruckdeschel JC,Codish SD,Stranahan A,et al.Postoperative empyema improves survival in lung cancer.Documentation and analysis of a natural experiment[J].N Engl J Med,1972,287(20):1013-1017.
17 Kolmel KF,Pfahlberg A,Mastrangelo G,et al.Infections and melanoma risk:results of a multicentre EORTC case-control study.European Organization for Research and Treatment of Cancer[J].Melanoma Res,1999,9(5):511-519.
18 Triarico S,Rinninella E,Cintoni M,et al.Impact of malnutrition on survival and infections among pediatric patients with cancer:a retrospective study[J].Eur Rev Med Pharmacol Sci,2019,23(3):1165-1175.
19 Cheng Y,Li H,Deng Y,et al.Cancer-associated fibroblasts induce PDL1+ neutrophils through the IL6-STAT3 pathway that foster immune suppression in hepatocellular carcinoma[J].Cell Death Dis,2018,9(4):422-429.
20 Grivennikov SI,Greten FR,Karin M.Immunity,inflammation,and cancer[J].Cell,2010,140:883-99.
21 Wojtukiewicz MZ,Sierko E,Hempel D,et al.Platelets and cancer angiogenesis nexus[J].Cancer Metastasis Rev,2017,36:249-262.
22 Gu L,Ma X,Wang L,et al.Prognostic value of a systemic inflammatory response index in metastatic renal cell carcinomaand construction of a predictive model[J].Oncotarget,2016,8(32):52094-52103.
23 Belusic-Gobic M,Zubovic A,Cerovic R,et al.Multivariate analysis of risk factors for postoperative wound infection following oral and oropharyngeal cancer surgery[J].J Craniomaxillofac Surg,2018,46(1):135-141.
24 Colotta F,Allavena P,Sica A,et al.Cancer-related inflammation,the seventh hallmark of cancer:links togenetic instability[J].Carcinogenesis,2009,30(7),1073-1081.

[1]	尹高平,王军力,张宇. 胃癌根治术后感染性并发症与患者T淋巴细胞亚群改变的相关性研究[J]. 实用肿瘤学杂志, 2015, 29(2): 106-110.
[2]	唐小军, 刘高华, 王小勇, 詹福生. 纵膈引流管对食管癌术后胸内吻合口瘘的治疗作用[J]. 实用肿瘤学杂志, 2014, 28(6): 535-539.
[3]	高冬梅张媛媛张璐朱明玥马斌林. 宫颈癌组织miR-221的表达及其与HPV感染的关联[J]. 实用肿瘤学杂志, 2014, 28(4): 299-304.
[4]	郑超, 陈明明, 张晓华, 刘文衡. 晚期肺癌合并白色念珠菌感染40例临床分析[J]. 实用肿瘤学杂志, 2008, 22(6): 534-534.
[5]	关晶波;郑秀兰. 超声造影在肾癌诊断中的应用现状及展望[J]. 实用肿瘤学杂志, 2008, 22(04): 393-395.
[6]	艾尼·阿不都热依木;雪来提·艾孜木;胡达拜尔迪·艾则孜;阿提右·艾则孜;买尔比亚·买买提斯地克;谢会忠. 105例维吾尔族胃癌临床分析[J]. 实用肿瘤学杂志, 2008, 22(02): 148-149,.
[7]	熊晓平;陈修己. 肾细胞癌中p53基因表达与预后关系的研究[J]. 实用肿瘤学杂志, 2004, 18(05): 339-340.
[8]	臧达;徐坚民;杨鹏;龚静山;饶梓彬;胡丽霞;李肃;贾贵静;王晓枚;庞春平. 肾细胞癌的CT表现与病理分析[J]. 实用肿瘤学杂志, 2004, 18(02): 89-91.
[9]	牟子新;杨光荣;王文龙. 肿瘤病人痰标本卡他布兰汉氏菌监测的临床意义[J]. 实用肿瘤学杂志, 2001, 15(04): 304-304.
[10]	李娟;罗绍凯;彭爱华. 血液系统恶性肿瘤患者化疗后感染的防治[J]. 实用肿瘤学杂志, 2001, 15(03): 207-209.
[11]	赵宁;刘杰;彭世云. 肺癌合并肺感染的临床药敏分析[J]. 实用肿瘤学杂志, 2001, 15(02): 151-152.
[12]	练向群;张翼;朱敬;万晓阳. 肿瘤手术吸引器管接口污染的调查[J]. 实用肿瘤学杂志, 2000, 14(04): 307-307.
[13]	柳市英;陈艳宁;孙冬梅. 肺癌合并肺感染致病菌耐药分析[J]. 实用肿瘤学杂志, 2000, 14(03): 229-230.