背景:肾部分切除术(PN)是治疗4cm以下肾细胞癌的金标准。对于>7cm(cT2)的肿瘤,没有可靠的数据推荐PN。这项工作的目的是评估PN对cT2肿瘤的结果。
方法:纳入了2000年至2013年间在我们机构接受PN或根治性肾切除术(RN)治疗cT2肿瘤的所有患者。患者人口统计学,术后数据包括肾功能,发病率,采用χ2检验对死亡率和肿瘤学结局进行回顾性分析和比较,曼-惠特尼测试,Kaplan-Meier法和对数秩检验。
结果:我们纳入了130名患者,PN组49例(38%),RN组81例(62%),中位随访时间为42个月[19-69]。术后第5天和最后一次记录值的肾功能变化在两组之间存在显着差异(P=0.03和P<0.001)。PN组的并发症发生率明显高于RN组(37%对14%,P=0.002)。两组之间的总体差异无统计学意义,无复发生存率和特异性生存率(分别为P=0.55,P=0.55,P=0.24)。在单变量分析中,手术类型(PN与RN)与肿瘤学结果的显着差异无关(切缘,生存)。
结论:PN可用于与RN相似的cT2肿瘤。尽管发病率增加,它仍然可以接受,并显示出保留肾功能的优势。
方法:4.
BACKGROUND: Partial nephrectomy (PN) is the gold standard treatment for renal cell carcinomas under 4cm. No robust data exists to recommend PN for tumours>7cm (cT2). The objective of this work is to evaluate the results of PN for cT2 tumours.
METHODS: All patients who underwent PN or radical nephrectomy (RN) for cT2 tumours between 2000 and 2013 at our institution have been included. Patient demographics, postoperative data including renal function, morbidity, mortality and oncologic outcomes were reviewed retrospectively and compared using χ2 test, Mann-Whitney test, Kaplan-Meier method and log rank test.
RESULTS: We included 130 patients, 49 (38%) in the PN group and 81 (62%) in the RN group, with a median follow-up of 42 months [19-69]. Variation of postoperative renal function at day 5 and last recorded value was significantly different between the groups (P=0.03 and P<0.001). The PN group had a significantly higher complication rate as compared with RN group (37% versus 14%, P=0.002). There were no significant differences between the two groups for overall, recurrence free and specific survival (P=0.55, P=0.55, P=0.24, respectively). In univariate analysis, the type of surgery (PN versus RN) was not associated with a significant difference of oncologic outcome (margins, survival).
CONCLUSIONS: PN can be offered for cT2 tumours with oncological outcomes similar to RN. Despite an increased morbidity, it remains acceptable with the demonstrated advantage of preservation of renal function.
METHODS: 4.