目的:探讨术前外周血中性粒细胞计数、淋巴细胞计数及两者比值对肾透明细胞癌(CCRCC)患者预后的意义.方法:回顾性分析初诊并术后病理证实的296例CCRCC患者的临床资料及随访情况,应用Cox回归分析的最小P值法获得三因素在计算总生存率时的最佳临界值,并以此为界值将患者分为低、高两组,分别应用Kaplan-Meier、Log-rank法和Cox回归模型进行单因素和多因素分析.结果:仅中性粒细胞最佳临界值(3.48×109/L即中位数,P=0.029)有统计学意义.低中性粒细胞组1年、3年、5年的总生存率(OS)和无进展生存率(PFS)分别为100％、100％、97％和99％、99％、92％,高中性粒细胞组1年、3年、5年的OS和PFS分别为98％、96％、94％和97％、93％、81％,两组OS(P=0.040)和PFS(P=0.021)比较有统计学意义.单因素分析显示,发病方式、中性粒细胞计数、肿瘤坏死情况、病理分级、病理T分期、肿瘤大小、病理TNM分期是以OS为终点事件的预后因素.同时,中性粒细胞计数、肿瘤大小、病理TNM分期也是以PFS为终点事件的预后因素.多因素分析显示,病理T分期(P =0.036)和TNM分期(P=0.011)是以PFS为终点事件的独立预后因素,中性粒细胞计数分别是以OS(P =0.029)和PFS(P =0.017)为终点事件的独立预后因素.结论:术前外周血中性粒细胞计数较高是CCRCC预后不良的独立预后因素.

Objectives To compare the therapeutic effects of nephron-sparing management versus radical nephroureterectomy management for low-grade upper tract urothelial carcinomas.Methods Literatures on the therapy of low-grade upper tract urothelial carcinoma by nephron-sparing management or radical nephroureterectomy management were collected from Pubmed,Springer,ScienceDirect,WANFANG,CNKI and CBM.Meta analysis was conducted for the date about the 5-year survival rate and disease-specific survival rate,according to Cochrane Collaboration.Results A total of 6 studies including 436 patients were identified and analyzed.The results showed no significant differences in the 5-year survival rate(RR =0.95,95 ％ CI =0.61 ～ 1.48,P ＞ 0.05) and 5 -year disease-specific survival rate(RR =0.83,95％CI =0.42 ～ 1.64,P ＞0.05).Conclusions A comparison between nephron-sparing management and radical nephroureterectomy management for low-grade upper tract urothelial carcinomas shows no significant differences in terms of 5-year survival rate and 5-year disease-specific survival rate,and has the same therapeutic effect; But the injury of the former is lower,so the clinicians could selectively use nephron-sparing management according to the individual differences of patients.

目的:探讨血浆降钙素原(PCT)水平变化在复杂性上尿路感染患者病情进展为尿脓毒血症的预警作用.方法:回顾性分析我院2012年1月～2013年11月收治的98例上尿路结石合并复杂性上尿路感染患者,患者均接受上尿路结石手术治疗,并分别在手术治疗前及术后第1天测定血浆PCT及C反应蛋白(CRP).参照2011版《中国泌尿外科疾病诊断治疗指南》对接受手术治疗后出现临床细菌感染症状并伴发全身炎症反应综合征(SIRS)的患者诊断为尿脓毒血症,按照患者在手术治疗后是否并发尿脓毒血症分为观察组和对照组,对观察组和对照组患者的血浆PCT水平差异进行统计学分析处理.结果:纳入本研究共98例患者中,手术治疗后并发尿脓毒血症(观察组)共48例,手术治疗后未并发尿脓毒血症(对照组)共50例,经过对两组患者不同阶段血浆PCT水平及C反应蛋白水平的差异进行统计学分析,两组间手术治疗前血浆PCT水平差异无统计学意义(P＞0.05),术后第1天两组血浆PCT水平较术前均升高,观察组术后第1天血浆PCT水平较术前明显升高,差异具有统计学意义(P＜0.05),对照组术后第1天血浆PCT水平较术前升高,统计显示差异具有统计学意义(P＜0.05),两组术后第1天血浆PCT水平比较,差异具有统计学意义(P＜0.01).结论:上尿路结石合并复杂性上尿路感染患者在接受手术治疗后,测定术后第1天血浆PCT水平可作为是否会并发尿脓毒血症的预警指标.

Objective To evaluate the prognostic significance of the preoperative elevated platelet count in patients with clear cell renal cell carcinoma (CCRCC). Methods The clinical data of 292 CCRCC patients, firstly diagnosed and confirmed by postoperative tissue diagnosis, was analyzed retrospectively and all of them were followed-up. The 292 patients were divided into normal and elevated groups by the value of platelet count (300×109/L). Kaplan-Meier and Log-Rank test were used to analyze the data. Prognostic factors of over survival (OS)and progression free survival (PFS) in these patients were analyzed by Cox proportional hazards model. Results 1 year, 3 years, 5 years overall survival rates and progression free survival rates were 100%, 99%, 97%and 99%, 97%, 86%in normal group and 89%, 84%, 84%and 86%, 81%, 81%in elevated group, respectively. OS(χ2=13.023, P=0.000) and PFS(χ2=3.968, P=0.046) between two group were statistically different.Univariate analysis showed that patients diagnosed with or without kidney triad, tumor size, tumor necrosis, pathological grade, T stage, TNM stage were prognostic factors of the OS in CCRCC patients and tumor size and TNM stage were also prognostic indicator of the PFS. Multivariate analysis showed that T stage and TNM stage were independent prognostic factors of the PFS for CCRCC and preoperative platelet count was an independent prognostic predictor of the OS. Conclusion The preoperative thrombocytosis is an independent poor prognostic factor for CCRCC.

目的:通过比较血清中早期前列腺癌抗原-2(EPCA-2)与前列腺特异性抗原(PSA)在前列腺癌(PCa)诊断中的特异性与敏感性,研究血清中EPCA-2对诊断PCa的临床意义.方法:收集非前列腺疾病患者20例(作为A组),BPH患者56例(作为B组),PCa患者44例(作为C组),采用酶联免疫吸附实验(ELISA)分别检测三组患者血清中EPCA-2和PSA水平,进行统计学分析.结果:①C组患者血清中EPCA-2和PSA水平分别与A组和B组患者的进行比较,均显著增高,差异有统计学意义(P＜0.01).②A组血清中EPCA-2水平均≤分界点(30 μg/L).③以30 μg/L为分界点,EPCA-2对PCa诊断的特异性为92.1％,敏感性为93.2％;以4μg/L为分界点,PSA对PCa诊断的特异性为55.3％,敏感性为79.5％;PSA结合fPSA/tPSA(以0.15为分界点),对PCa诊断的特异性为78.9％,敏感性为68.2％.结论:EPCA-2作为新的诊断PCa的肿瘤标志物,较PSA具有更高的特异性和敏感性,对临床PCa的诊断具有重要意义.