Lau W K, Blute M L, Weaver A L, Torres V E, Zincke H
Department of Urology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
Mayo Clin Proc. 2000 Dec;75(12):1236-42. doi: 10.4065/75.12.1236.
To report the long-term follow-up of a matched comparison of radical nephrectomy (RN) and nephron-sparing surgery (NSS) in patients with single unilateral renal cell carcinoma (RCC) and a normal contralateral kidney.
Between August 1966 and March 1999, 1492 and 189 patients with unilateral RCC and a normal contralateral kidney underwent RN and NSS, respectively. Patients with renal impairment, previous nephrectomy, bilateral or multiple RCCs, metastasis, and familial cancer syndromes were excluded. A total 164 patients in each cohort were matched according to pathological grade, pathological T stage, size of tumor, age, sex, and year of surgery. The Kaplan-Meier method and stratified Cox proportional hazards model were used to estimate and compare overall, cancer-specific, local recurrence-free, and metastasis-free survival and survival free of chronic renal insufficiency. The 2 groups were evaluated for early (< or = 30 days) complications and proteinuria at last follow-up.
At last follow-up, 126 RN patients (77%) and 130 NSS patients (79%) were alive with no evidence of disease. There was no significant difference observed between patients who had RN and those who had NSS with respect to overall survival (risk ratio, 0.96; 95% confidence interval [CI], 0.52-1.74; P = .88) or cancer-specific survival (risk ratio, 1.33; 95% CI, 0.30-5.95; P = .71). At 10 years, similar rates of contralateral recurrence (0.9% for RN vs 1% for NSS) and metastasis (4.9% for RN vs 4.3% for NSS) were seen in each group, whereas the rate of ipsilateral local recurrence for patients who underwent RN and NSS was 0.8% and 5.4%, respectively (P = .18). There was no significant difference in the early complications between the RN and NSS groups. However, patients who underwent RN had a significantly higher risk for proteinuria as defined by a protein/osmolality ratio of 0.12 or higher (55.2% vs 34.5%; P = .01). At 10 years, the cumulative incidence of chronic renal insufficiency (creatinine > 2.0 mg/dL at least 30 days after surgery) was 22.4% and 11.6%, respectively, for the RN and NSS groups (risk ratio, 3.7; 95% CI, 1.2-11.2; P = .01).
This retrospective study of patients with unilateral RCC and a normal contralateral kidney suggests that NSS is as effective as RN for the treatment of RCC on long-term follow-up. The increased risk of chronic renal insufficiency and proteinuria after RN supports use of NSS.
报告对单侧肾细胞癌（RCC）且对侧肾脏正常的患者进行根治性肾切除术（RN）与保留肾单位手术（NSS）的配对比较的长期随访结果。
1966年8月至1999年3月期间，分别有1492例和189例单侧RCC且对侧肾脏正常的患者接受了RN和NSS手术。排除有肾功能损害、既往肾切除术史、双侧或多发RCC、转移及家族性癌症综合征的患者。根据病理分级、病理T分期、肿瘤大小、年龄、性别和手术年份，在每个队列中各匹配164例患者。采用Kaplan-Meier法和分层Cox比例风险模型来估计和比较总生存、癌症特异性生存、无局部复发生存和无转移生存以及无慢性肾功能不全生存情况。对两组患者的早期（≤30天）并发症及最后一次随访时的蛋白尿情况进行评估。
在最后一次随访时，126例（77%）接受RN手术的患者和130例（79%）接受NSS手术的患者存活且无疾病证据。接受RN手术的患者与接受NSS手术的患者在总生存（风险比，0.96；95%置信区间[CI]，0.52 - 1.74；P = 0.88）或癌症特异性生存（风险比，1.33；95% CI，0.30 - 5.95；P = 0.71）方面未观察到显著差异。10年时，每组中对侧复发率（RN组为0.9%，NSS组为1%）和转移率（RN组为4.9%，NSS组为4.3%）相似，而接受RN和NSS手术的患者同侧局部复发率分别为0.8%和5.4%（P = 0.18）。RN组和NSS组的早期并发症无显著差异。然而，接受RN手术的患者出现蛋白尿（定义为蛋白/渗透压比值≥0.12）的风险显著更高（55.
