老年（≥75岁）肾癌患者腹腔镜手术术后并发症的影响因素及预后分析

Influencing factors and prognosis of postoperative complications in elderly (≥75 years) patients with renal cell carcinoma after laparoscopic surgery

摘要

目的 分析老年肾癌患者腹腔镜手术术后并发症及生存结局，分析相关影响因素，为临床提升该类患者群体的腹腔镜手术安全性提供参考。方法 回顾性分析2012-2025年于北京大学第三医院行腹腔镜肾癌手术的153例≥75岁的老年患者的临床、手术、病理及随访资料。采用logistic回归分析影响老年肾癌患者术后并发症的因素，构建并验证预测老年肾癌患者术后并发症的列线图模型。采用Kaplan-Meier法绘制生存曲线，分析不同术式对患者预后的影响以及在各年龄亚组（75～<80岁、≥80岁）中的生存差异。采用Cox回归分析影响老年肾癌患者生存预后的因素。结果 153例患者中有15例出现术后并发症，其中严重并发症5例。多因素logistic回归分析显示查尔森合并症指数（CCI）≥3、手术时间延长是老年肾癌患者腹腔镜手术术后并发症发生的独立影响因素（P<0.05）。基于年龄、CCI≥3及手术时间构建的老年肾癌患者术后并发症列线图预测模型的C指数为0.77（95%CI：0.64～0.90），平均绝对误差为1.6%。在亚组分析中75～<80岁接受肾部分切除术患者总生存率优于接受肾根治性切除术患者（P=0.0056），≥80岁接受不同术式的肾癌患者总生存率差异无统计学意义（P=0.062）。多因素Cox回归分析显示术前低白蛋白水平、术前肾功能不全、肿瘤直径>4 cm和病理分期是影响老年肾癌患者总生存期的独立危险因素（P<0.05）。结论 老年肾癌患者腹腔镜手术安全有效，生存预后和患者营养状态、肾功能情况、肿瘤大小和病理分期相关。≥80岁肾癌患者仍可从手术治疗获益，且该年龄段接受不同术式治疗的患者生存率无差异。

Abstract

Objective To analyze the postoperative complications and survival outcomes of elderly patients with renal cell carcinoma undergoing laparoscopic surgery, and to identify the influencing factors, so as to provide reference for improving the safety of laparoscopic surgery in such patients. Methods A retrospective analysis was conducted on the clinical, surgical, and pathological data of 153 patients aged ≥75 years who underwent laparoscopic nephrectomy for renal cell carcinoma at our hospital during 2012 and 2025. Logistic regression analyses were performed to identify factors influencing postoperative complications, and a nomogram was constructed and validated to predict the complications. Kaplan-Meier method was used to draw the survival curve, and the effects of different surgical approaches on the prognosis and the survival difference in the age subgroups (75-<80 years, ≥80 years) were analyzed. Cox regression analyses were conducted to determine factors affecting survival outcomes. Results Among the 153 patients, 15 developed postoperative complications, including 5 severe cases. Multivariate logistic regression identified Charlson Comorbidity Index(CCI) ≥3 and prolonged operation time as independent risk factors for postoperative complications(P<0.05). The C-index of the logistic regression model constructed based on these factors(age, CCI≥3 and operation time) was 0.77 (95%CI: 0.64-0.90), with an average absolute error of 1.6%. Subgroup analysis revealed superior overall survival in patients aged 75-<80 years undergoing partial nephrectomy compared to radical nephrectomy(P=0.0056). No statistically significant difference in overall survival was observed among patients ≥80 years who received different surgical approaches(P=0.062). Multivariate Cox regression analysis identified preoperative low albumin levels, preoperative renal insufficiency, tumor diameter >4 cm, and pathological stage as independent risk factors for overall survival (P<0.05). Conclusion Laparoscopic surgery is safe and effective for elderly patients with renal cell carcinoma, with survival outcomes correlated to nutritional status, renal function, tumor size and pathological staging. Patients aged ≥80 years still derive surgical benefit, and no survival differences exist between different surgical approaches in this age group.

关键词

肾细胞癌 / 老年 / 腹腔镜手术 / 预后

Key words

renal cell carcinoma / elderly patients / laparoscopic surgery / prognosis

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