腹腔镜下肾部分切除术的优势在于对残肾功能的保护,在手术中减少热缺血相关肾实质损伤是临床上的难点问题.目前最短血流阻断技术被广泛应用,但此类方法可能增加术中出血的风险.为达到提高围手术期安全性和减少肾功能损伤的平衡,本中心对标准早期开放、"2+1"缝合法及早期序贯开放血流法3种技术进行了比较分析,并总结出合理运用上述方法的初步经验,本文就其手术步骤及适用条件做简要介绍.

目的:探讨肾肿瘤悬吊法在“零缺血”腹腔镜下肾部分切除术中的应用价值.方法:回顾性分析2017年1月～2018年1月海军军医大学附属公利医院和海军军医大学附属东方肝胆外科医院12例患者应用肾肿瘤悬吊法在完全无肾动脉阻断的“零缺血”条件下开展腹腔镜下肾部分切除术,收集患者的一般临床基线资料,在后腹腔镜下采用肾肿瘤悬吊法行“零缺血”肾部分切除术:游离肾周脂肪暴露肾肿瘤,但保留肾肿瘤上方的脂肪.取肿瘤上方的脂肪向上提拉,用Hem-o-lock将肿瘤上方脂肪悬吊到上方筋膜、腹膜反折等组织(具体可根据术中情况评估选择)上,使肿瘤与肾脏之间保持一定的张力.使用腹腔镜剪刀在肿瘤周围0.5 cm左右处分离肿瘤,另外一个操作孔置入腹腔镜下吸引器,将肾脏创面的出血充分吸走,保持视野清晰并帮助调整瘤体方向,保证完整切除肿瘤,对肾脏创面进行连续缝合.收集12例患者的手术时间、肿瘤切除并缝合时间、术中出血量、术后引流管留置天数、术后并发症、术后住院天数等指标,记录术后6个月患肾肾小球滤过率(GFR)、血红蛋白及肌酐等相关实验室指标以及肿瘤学预后指标,进行统计分析.结果:12例患者均成功实施肾肿瘤悬吊法腹腔镜下“零缺血”肾部分切除术,无改行肾动脉阻断或者中转开放手术病例,手术成功率达100％,中位手术时间为105(70～135) min,中位肿瘤切除并缝合时间为17(14～25) min,中位术中出血量185(70～350) mL,中位术后引流管留置时间为5(4～6)d,中位术后住院天数为6(5～7)d,术后无出血、尿漏、感染、切口裂开等相关并发症.12例患者术后6个月复查肾脏CT、胸部CT等未见肿瘤复发、转移,术前以及术后6个月血红蛋白指标、肌酐水平、患肾GFR差异无统计学意义.结论:完全无阻断的“零缺血”腹腔镜下肾部分切除术术中应用肿瘤悬吊法能够保证手术的安全性和可行性,最大程度地保护肾功能,使患者在肾部分切除术中能够得到最大程度的获益.

目的:探讨肾周脂肪平均密度对腹腔镜肾部分切除术的影响.方法:回顾性分析2014年4月～2018年4月上海长征医院泌尿外科135例腹腔镜肾部分切除术患者.通过CT影像学资料对肾周脂肪平均密度进行计算,并将患者分为高密度组和低密度组,比较两组患者手术时间、BMI、术中出血、R.E.N.A.L、PAUDA评分及肾周脂肪平均密度等指标.结果:高密度组与低密度组手术时间比较差异有统计学意义(P＜0.05),两组患者在BMI、术中出血量、肾周脂肪厚度(PD)等方面比较差异无统计学意义.结论:本研究发现MAP肾周脂肪评分无法准确地评估肾周脂肪含量,而肾周脂肪平均密度可作为肾周脂肪的评估指标.

目的:探讨分析高血压不良反应与舒尼替尼治疗晚期转移性肾癌疗效的相关性.方法:回顾性收集我院2009年1月～2016年6月65例舒尼替尼治疗的晚期转移性肾癌患者的临床资料,男42例,女23例;年龄44～75岁,平均63岁;84.6％的患者接受手术治疗(肾癌根治性切除或保留肾单位切除),肿瘤病理均为肾透明细胞癌,最常见的转移部位为肺(73.8％).所有患者均采用舒尼替尼标准治疗方案:50 mg/d,服用4周,停用2周.每2个周期通过CT检查评价药物疗效,每个疗程的第1天和第28天检测血压.比较有无舒尼替尼诱导的高血压不良反应[收缩压≥140 mmHg(1 mmHg=0.133 kPa)或者舒张压≥90 mmHg]对肿瘤疗效的影响.结果:服用靶向药物期间,根据是否出现高血压不良反应进行分组,分为高血压组(30例)和血压正常组(35例),两组基线特征比较差异均无统计学意义.高血压不良反应在舒尼替尼治疗的第1疗程或者第2疗程出现,出现收缩期的高血压(中位时间:第1疗程,1～9疗程)比舒张期的高血压(中位时间:第2疗程,1～11疗程)更为早期.在12个月的随访中,高血压组客观有效率(ORR)显著高于血压正常组(56.7％ vs.28.6％,P=0.016).同时亚组分析收缩期高血压组或舒张期高血压组与收缩压正常组或舒张压正常组比较差异均有统计学意义(P=0.039、P=0.038).长期随访过程中,高血压组平均无进展生存期(PFS)较血压正常组显著延长(13.4个月vs.8.7个月,P=0.002).结论:在舒尼替尼治疗过程中,晚期转移性肾癌患者出现高血压不良反应可获得更好的肿瘤控制,更长的PFS,适合作为预测靶向药物疗效的有效指标.

Objective To explore the efficacy and tolerance of adverse reactions of gene detection technique in guiding individualized targeted therapy for advanced metastatic renal cell carcinoma.Methods Retrospective analysis was performed on the clinical data of 62 patients with advanced metastatic renal cell carcinoma before and after receiving targeted drug treatment in our department from October 2015 to October 2017.Among the 62 patients,there were 36 males and 26 females,with an average age of (54 ± 13) years old.16 patients were treated with sunitinib,20 patients were treated with sorafenib and 26 patients were treated with pazopanib.A total of 28 patients (individualized group) were selected to receive targeted drug according to the results of gene detection,and 34 patients were treated with targeted drug empirically (empirical group).In individualized group,there were 17 males and 11 females with the average age of (51.3 ± 15.6) years old.20 patients accepted the operation.The distant metastasis included bone metastasis in 21 cases,lung metastasis in 7 cases,liver metastasis in 16 cases,epidermal metastasis in 4 cases and lymphatic metastasis in 14 cases.According to risk of MSKCC,the case number of low risk,moderate risk and high risk were 15,7,6,respectively.7 patients were treated with sunitinib,8 patients were treated with sorafenib and 13 patients were treated with pazopanib.In empirical group,there were 19 males and 15 females with the average age of (56.3 ± 10.1) years old.22 patients accepted the operation.The distant metastasis included bone metastasis in 20 cases,lung metastasis in 5 cases,liver metastasis in 13 cases,epidermal metastasis in 3 cases and lymphatic metastasis in 15 cases.According to risk of MSKCC,the case number of low risk,moderate risk and high risk were 20,g,6,respectively.9 patients were treated with sunitinib,12 patients were treated with sorafenib and 13 patients were treated with pazopanib.The baseline characteristics of the two groups of patients,including gender,age,whether operation was performed,site of metastasis,and risk of MSKCC,didn't show significant difference.Patients in both groups received the standard treatment regimen and the follow-up duration was 4-26 months to observe the efficacy,progression-free survival and tolerance to adverse reactions of the targeted therapy.Results After 12 months of treatment,15 patients in the individualized group was recorded objective remission.7 patients in the empirical group was recorded objective remission,as well.The tumor control efficacy of the individualized group was significantly better than that of the empirical group (46.4％ vs.20.6％,P =0.03).Meanwhile,the median progression-free survival time (15.2 months,3.7-24.2 months) in the individualized group was significantly longer than that in the empirical group (12.1 months,2.8-22.1 months) (P =0.009).Compared with the empirical group,the higher incidence of targeted treatment-related adverse reactions occurred in the individualized group,including thrombocytopenia (46.4％ vs.17.6％ P =0.014),leukopenia (46.4％ vs.17.6％ P =0.005),hypertension (71.4％ vs.44.1％,P =0.031) and hypothyroidism(60.7％ vs.29.4％,P=0.013).Conclusions Compared with the patients with empirical drugs,the application of gene detection technique to select individualized targeted drugs for the treatment of advanced metastatic renal cancer is obvious curatively effective,and to a certain extent extends the progression-free survival time of patients.

目的:探讨分析培唑帕尼新辅助治疗在减瘤性肾切除术治疗转移性肾癌患者中的安全性和有效性.方法:回顾性分析2017年9月～2018年4月接受培唑帕尼新辅助治疗的5例晚期转移性肾癌患者的临床资料,男3例,女2例,平均年龄60(48～69)岁,4例患者存在肺部转移,2例患者存在骨转移(分别为腰椎和肋骨).培唑帕尼新辅助治疗方案:800 mg口服1次/d,连续性服用12～14周,每4周通过CT检查评价药物疗效,明确临床疗效后接受减瘤性肾切除术治疗.主要观察指标包括靶向药物不良反应、疗效、围手术期患者一般情况等.结果:培唑帕尼靶向治疗12～14周后,2例患者原发肾肿瘤病灶缩瘤(缩瘤率分别26.9％和12.4％),处于部分缓解(PR)状态;1例患者原发肾肿瘤病灶处于稳定(SD)状态;1例患者原发肾肿瘤出现疾病进展(PD),终止了培唑帕尼新辅助治疗;1例患者新辅助服药期间出现严重的腹泻不良反应,患者放弃培唑帕尼新辅助治疗计划.靶向获益的3例患者接受了减瘤性患肾切除术治疗,2例肿瘤病理为肾透明细胞癌,1例为成人肾母细胞瘤.术后恢复良好,无出血、伤口愈合延迟、血肌酐升高等常见并发症.术后2～3周继续服用培唑帕尼.术后随访,远处转移灶(肺、骨)控制良好,尚未见PD.结论:培唑帕尼新辅助治疗可以安全、有效地应用于晚期转移性肾癌患者的减瘤性患肾切除术,但仍需要前瞻性随机对照研究进行验证.

目的:探讨分析早期开放血流法在肾肿瘤腹腔镜肾部分切除术中的安全性及有效性.方法:回顾性分析2016年1月～2017年6月在我院行腹腔镜下肾部分切除术的60例肾肿瘤患者的临床资料.其中男35例,女25例,平均年龄(59.57±11.18)岁;平均肿瘤直径(4.40±0.93) cm;背侧40例,腹侧20例.肾动脉早期开放血流法简要手术过程:①肾动脉阻断下,切除肾肿瘤,缝合肾创面血管及集合系统;②肾动脉解除阻断(开放血流)下,缝合关闭肾外层创缘.结果:60例肾肿瘤患者均顺利完成腹腔镜下肾部分切除术,其中28例患者采用肾动脉早期开放血流(早期开放血流组),32例患者采用传统肾动脉全阻断(传统全阻断组).两组肾肿瘤患者基线特征相关指标(年龄、性别、肿瘤大小、肿瘤位置、R.E.N.A.L.评分)差异无统计学意义.早期开放血流组和传统全阻断组术中平均手术时间[(103.93±29.86) min vs.(105.00±26.27)min]和术后住院天数[(6.35±1.14)dvs.(6.49±1.02) d]比较差异均无统计学意义.早期开放血流组平均出血量多于传统全阻断组[(107.14±28.53) ml vs.(83.44±31.38) ml,P＜0.01],但两组患者均无输血事件发生.早期开放血流组热缺血时间显著低于传统全阻断组[(14.89±4.21)min vs.(21.84±4.30) min,P＜0.01].术后传统全阻断组出现1例出血并发症,两组均无切缘阳性并发症发生.术后1年随访中,两组肾功能恢复比较差异无统计学意义,未见肿瘤复发转移.结论:肾动脉早期开放血流法,显著缩短肾部分切除术的热缺血时间,是一种安全可行的手术方式,值得临床应用推广.

目的:总结改良经腹膜后入路腹腔镜肾部分切除术治疗巨大囊性肾癌的操作体会.方法:共收治12例巨大囊性肾占位患者,肿瘤最大径56～78 mm,术前影像学检查考虑为囊性肾癌.术中先在经腹膜后入路腹腔镜视野下操作,分离出肾动脉备用,并尽可能分离部分囊性占位;然后改为开放手术操作,进一步完整分离出肿瘤,在完全长时间阻断前,行肾脏缺血预适应操作.完全阻断肾动脉,行肾部分切除术.采用"n+1"缝合技术,缝合肾脏创面.结果:12例患者均顺利完成手术.热缺血时间平均(29.1±7.2)min,术中出血量平均(256.5±40.1)mL,术后病理结果均提示为透明细胞癌,Fuhrman核分级Ⅰ级10例、Ⅰ～Ⅱ级2例.术后随访,均未见肿瘤复发,肾小球滤过率表现为较术前轻中度下降,6例患者存在部分肾盏轻度积水.结论:采用改良经腹膜后入路腹腔镜肾部分切除术治疗巨大囊性肾癌,同时达到了"保肾"、"去瘤"的两个目的,治疗效果较好.

Objective To analyze the value of early sequential unclamping method in laparoscopic partial nephrectomy.Methods From April 2017 to October 2017,a total of 8 cases of renal tumor patients by early sequential unclamping method of laparoscopic partial nephrectomy (LPN) were reviewed,with 5 males and 3 females and average age of 56.4 years (43-70 years).Three cases of renal tumor were located on the left side,5 cases on the right side.The mean tumor diameter was 5.6 (4.6-6.4) cm.The preoperativeR.E.N.A.L.score was 8.8 (7-10),and the mean ASA score was 1.4 (1-2).Preoperative serum creatinine level was 89.5 (72.1-104.2) μmol/L,and the GFR level of the kidney with tumor before operation was 55.5 (40.4-62.3) ml/min.The early sequential unclamping method was used for retroperitoneal laparoscopic partial nephrectomy:according to the preoperative CTA results,the main branches and branches of the renal artery were routinely separated.Before the tumor resection,the branches of renal artery and the main renal artery were sequentially blocked.After removal of the tumor,the first layer of bare kidney wound blood vessels and collection system were sutured and repaired.Then released the main renal artery occlusion clamp,restored most of the blood supply to the kidney,but kept the tumor-specific segmental renal artery blocked.Continuous suture of the kidney created a rough combination of the renal wound.After second layers of suture completed,unclamped the segmental renal artery and sutured the renal wound again,made the third layers of suture intersecting with the second seam suture to strengthen the hemostatic effect.Results All the 8 patients were performed LPN with early sequential unclamping method successfully.The average operative time was 132.5 (90-180) min,the intraoperative blood loss was 142.5 (100-200) ml,the completely warm ischemia time was 15.5 (12.0-20.0) min,and no blood transfusion was performed intraoperatively and postoperatively.The operative margin was negative.The postoperative pathology showed that 7 cases were clear cell carcinoma and 1 cases of papillary cell carcinoma.Postoperative complications such as urinary leakage,incision infection and fever were not found.Drainage tube removal time was 3.5 (3-5) days and the time of postoperative hospitalization was 4.8 (4-6) days.At 1 months after operation,the serum creatinine level was 94.0 (83.6-101.2) μmol/L and the GFR level of one side kidney with tumor was 52.3 (43.2-59.6) ml/min.After 2-9 months of follow-up,there was no recurrence of the tumor.Conclusions Early sequential unclamping method could shorten the warm ischemia time and reduce the risk of bleeding during the operation.It also maintains a clear operative field,which could reduce the difficulty of laparoscopic partial nephrectomy and make a more accurate tumor resection in the complex renal tumor patients.

Objective:To explore the application of preplaced suture technique in zero ischemia laparoscopic partial nephrectomy (LPN) and evaluate the value of clinical efficacy and prognosis.Method:Twelve patients with renal tumors underwent non-hilar clamping LPN between January 2015 to February 2016 in our hospital.There were eight males and four females with an average age of 54.75 (range,39-71) years old.The renal tumors were located in the right side in seven cases and in the left side in five cases.The average tumor diameter was 1.95 (range,1.5-2.5) cm.The average preoperative R.E.N.A.L score was 4.7 (range,5-7) and ASA was 1.58 (range,1-2).Using preplaced suture technique in LPN:pre-suture a 1-0 QUILL SRS suture in normal renal parenchyma adjacent to the tumor about 1 cm,do not tighten the suture.Separate the tumor between the preplaced suture and tumor.When bleeding occurred,pull or tighten the suture to stop bleeding.If bleeding cannot control,then use the preplaced suture directly suture the exposed wound,repeated to complete the tumor resection.If the amount of bleeding is acceptable,we can suture the renal parenchyma using the preplaced suture after complete resection of the tumor.Result:LPN was successfully carried out in all cases.There was no temporary hilar clamping during the operation.The average operation time was 105.8 (range,70-150) min.The average blood loss during operation was 85.8 (range,40-150) ml.There was no blood transfusion during operation or after operation.Pathology showed 11 patients with renal cell carcinoma (RCC) and 1 with papillary carcinoma.There were no complications such as urinary leakage,incision infection or fever.The average hospitalization time was 5.3 (range,4-7) days.Follow-up of 6-12 months,no obvious abnormal renal function or tumor recurrence was found.Conclusion:Zero ischemia LPN is expected to be completed successfully without additional surgical procedures by using the preplaced suture technique,thus we can maximize the clinical benefits for patients in renal function reservations by avoiding the kidney injury caused by warm ischemia.

Objective To explore the feasibility of 3D printing technique combined with intra-operative ultrasound for locating completely endophytic renal tumor in lapamscopic nephron-sparing surgery.Methods Fifteen patients with completely endophytic renal tumor,who undervwent 3D printing technique combined with intra-operative ultrasound assisted localization of laparoscopic partial nephrectomy from Mar.2014 to Mar.2016,received CT image 3D reconstruction and 3D printing kidney model using Fommlab Form1 + 3D printer before operation.Among 15 patients aging (55.7±10.5) years,11 patients were male and 4 were female;the tumor diameter was (2.8±1.0) cm;and 3 cases were ventral and 12 were dorsal,all had solitary tumors.The clinical data,including intra-operative blood loss,warm ischemia time,post-operative pathology and surgical margins,and post-operative renal function,were statistically analyzed in this study.Resuits Laparoscopic partial nephrectomy was successfully carried out in all cases:the average operation time was (105.0± 20.6) min,the average warm ischemia time was (22.8 ± 3.5) min,and the mean intra-operative blood loss was (87.3±15.8) mL.No case received blood transfusion during or after operation,and the average post-operative hospital stay was (6.7 ± 1.0) days.No obvious complication occurred after operation.The surgical margins were all negative.Post-operative pathology confirmed that 13 patients were with clear cell renal cell carcinoma,and 2 with papillary renal cell carcinoma.Patients were followed up for (23.7± 11.8) months,and nocontinuous deterioration of renal function or tumor recurrence was found.Conclusion Pre-operative 3D printing technique for patients with completely endophytic renal tumor can help to determine the tumor location and adjacent relationship,reducing the risk of surgery by guiding operation scheme.Meanwhile,propaganda and education using 3Dprinting kidney model can improve patients ' cognition to surgery and simplify pre-operative conversation process.Furthermore,utilizing intra-operative ultrasound to optimize tumor resection scheme can reduce the damage to the renalvessels and collection system,maximizing the clinical benefit by ensuring negative margin and renal function reservation.

目的:比较分析后腹腔镜下肾部分切除术改进方法治疗中度复杂性肾癌的临床疗效及预后.方法:回顾性分析2012年9月～2014年9月R.E.N.A.L.评分为中度复杂肾癌(7～9分)并在我院行后腹腔镜下肾部分切除术的84例患者的临床资料,其中男56例,女28例,平均年龄(51.5±10.5)岁,肾脏肿瘤均为单发,其中腹侧12例,背侧72例,肿瘤直径(52±23)mm,R.E.N.A.L.平均评分为(8.1±0.92)分.结果:84例患者均顺利完成后腹腔镜下肾部分切除,其中采用“2+1”法(改良组)48例,标准肾部分切步骤(对照组)手术36例,两组在平均手术时间[(104.2±31.6) minvs.(97.0±21.9) min),P＞0.05]、术中出血量[(81.9±8.7) mlvs.(78.9±7.9) ml,P＞0.05)]、术后血清肌酐[(91±29) μmol/L vs.(93±42) μmol/L,P＞0.05)]、术后血红蛋白减少值[(2.2±1.8) g/mlvs.(1.9±1.3) g/ml,P＞o.05)]、术后住院天数[(6.o±2.0)d vs.(6.0±3.3)d,P＞0.05]等方面差异无统计学意义,但采用“2+1”缝合法热缺血时间显著减少[(14.1±3.3) min vs.(17.6±4.9) min,P＜0.01)].术后尿漏2例(改良组1例,对照组1例);高热(体温＞39.0℃)两组各1例.术后平均随访(19.6±2.3)个月,所有患者未见肿瘤复发或转移,肾功能无持续恶化.结论:“2+1”缝合法改良早期开放肾阻断钳技术及缝合方法,使热缺血时间显著缩短,扩大了肾部分切的适应证,保证患者术后生活质量,是一种安全高效的肾部分切手术方法,值得向临床推广.

目的:分析代谢综合征和肾癌恶性程度的相关性.方法:收集2013年1月～2016年1月期间我院收治的668例肾癌手术治疗患者的一般资料,根据有无代谢综合征分为单纯性肾癌组和肾癌合并代谢综合征组.统计分析两组间肾癌Fuhrman分级的差异.结果:本研究共纳入668例肾细胞癌患者,平均年龄为(62.7±9.0)岁,男性451例,女性217例,病理类型为透明细胞癌588例,非透明细胞癌80例.单纯肾癌组包含552例患者,平均年龄(62.5±9.0)岁,男性375例,女性177例,病理类型为透明细胞癌486例,非透明细胞癌66例.Fuhr-man分级Ⅰ、Ⅱ级399例,Fuhrman分级Ⅲ、Ⅳ级153例;肾癌合并代谢综合征组包括116例患者,平均年龄(63.7±8.9)岁,男性76例,女性40例,病理类型为透明细胞癌102例,非透明细胞癌14例.Fuhrman分级Ⅰ、Ⅱ级71例,Fuhrman分级Ⅲ、Ⅳ级45例.肾癌合并代谢综合征组患者的Fuhrman分级明显高于单纯肾癌组,且存在统计学意义(P=0.018).结论:肾癌伴有代谢综合征预示了更高的恶性程度.

目的:探讨单中心14例晚期肾癌患者应用舒尼替尼4/2方案行新辅助分子靶向治疗的临床疗效及经验.方法:回顾性分析2010年12月～2014年12月14例晚期肾癌患者行舒尼替尼新辅助靶向治疗的临床资料,所有患者术前应用舒尼替尼4/2方案2个周期的治疗后予以手术切除,收集患者的一般资料、舒尼替尼治疗的不良反应、手术方式、手术时间、手术失血量、围手术期并发症、病理学资料以及预后信息.结果:14例患者在术前接受舒尼替尼分子靶向治疗后,4例肾癌病灶出现不同程度的缩小,14例患者术中发现肿瘤病灶的血供均明显减少.术后随访提示患者恢复良好.结论:舒尼替尼新辅助靶向分子治疗不但能够缩小部分晚期肾癌患者的病灶,并且能够明显降低肾癌病灶血供,从而降低手术的难度及风险,给部分难以手术治疗的患者提供手术减瘤的机会.并且患者的围手术期死亡率及并发症的发生率无显著增加.

目的:探讨舒尼替尼相关性血液学不良反应与晚期肾细胞癌的预后关系.方法:选取2010年6月～2014年6月上海长征医院泌尿外科收治的56例晚期肾癌患者,29例行肾脏原发病灶切除术,病理诊断为肾透明细胞癌.治疗方案:舒尼替尼50 mg,1次/d,采用4/2方案,即每治疗4周停2周为1个周期;每治疗1个周期或2个周期通过CT或MRI评价药物疗效.每周期血常规、肝肾功能检查评价不良反应.结果:中性粒细胞减少组,完全缓解(CR)2例(5.5％),部分缓解(PR)9例(25.0％),疾病稳定(SD)ll例(30.6％),ORR为30.6％(8例);中性粒细胞正常组,CR l例(5.0％),PR 2例(l0.0％),SD 8例(40.0％),ORR为15.0％(3例).中性粒细胞减少组患者的ORR高于中性粒细胞正常组患者的ORR,但差异无统计学意义.中性粒细胞减少组无进展生存期(12.2个月,95％CI:10.8～13.6)较正常组(8.7个月,95％CI:6.9～10.4)显著延长(P=0.007).血小板下降组相较血小板正常组患者中位疾病无进展时间明显延长(P=0.011),中性粒细胞/淋巴细胞比率(＜2)较中性粒细胞/淋巴细胞比率(≥2)的患者中位疾病无进展时间明显延长(P=0.008).结论:在舒尼替尼治疗中出现一些血液学不良反应的晚期肾细胞癌患者的中位无疾病进展时间更长,这些血液学不良反应可以作为预测药物疗效的有效指标.