Blute Michael L, Thibault Gregory P, Leibovich Bradley C, Cheville John C, Lohse Christine M, Zincke Horst
Department of Urology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
J Urol. 2003 Sep;170(3):760-3. doi: 10.1097/01.ju.0000081422.47894.e6.
Unrecognized sporadic multifocality at planned nephron sparing surgery (NSS) presents a surgical dilemma. We report a single institution experience with patients presenting with multiple ipsilateral renal tumors, of which at least 1 was renal cell carcinoma (RCC). We determined the outcome for patients treated with NSS or radical nephrectomy (RN).
A total of 118 patients underwent surgery between 1970 and 2000 for sporadic multiple ipsilateral renal tumors, of which at least 1 was RCC. The patients were treated with RN (102) and NSS (16). Clinical features recorded included age at surgery, sex, history of smoking, a preexisting solitary kidney and symptomatic disease at presentation. Pathological features included histological subtype, nuclear grade, tumor stage (2003 TNM) and tumor size. Cancer specific survival was estimated using the Kaplan-Meier method.
A greater proportion of patients treated with NSS had a solitary kidney compared with patients treated with RN (6 or 38% versus 0, p <0.001). Of the 102 patients treated with RN for multiple tumors 12 died of RCC at a median time to death of 3.3 years (range 3 months to 9.5 years). Estimated cancer specific survival at 5 years was 90.1%. There was metachronous contralateral recurrence in 5 patients a median of 8.1 years following RN (range 3 months to 14 years). Two of the 16 patients treated with NSS died of RCC 6 and 11 years following NSS, respectively, for a cancer specific survival rate of 100% at 5 years. Two patients had local renal recurrence 1.7 and 2.8 years following NSS, respectively, and a metachronous contralateral renal tumor was found in 1 patient 7 months following NSS. Of the 102 patients treated with RN 63 (62%) and 9 of the 16 (56%) treated with NSS had at least 1 clear cell RCC. In 23 of the 102 patients (23%) treated with RN only 1 tumor was RCC, while the remainder were benign, suggesting that these patients were potential candidates for NSS.
Patients undergoing RN or NSS for multiple ipsilateral renal tumors, of which at least 1 is RCC, have favorable cancer specific survival. The metachronous contralateral recurrence rate for patients with sporadic multifocal lesions is approximately 5%. Planned NSS may not be abandoned if satellite lesions are benign.
在计划性保留肾单位手术（NSS）中未被识别的散发性多灶性病变带来了手术难题。我们报告了一家机构对患有多个同侧肾肿瘤患者的治疗经验，其中至少有1个是肾细胞癌（RCC）。我们确定了接受NSS或根治性肾切除术（RN）治疗的患者的结局。
1970年至2000年间，共有118例患者因散发性多个同侧肾肿瘤接受手术，其中至少有1个是RCC。这些患者接受了RN（102例）和NSS（16例）治疗。记录的临床特征包括手术时年龄、性别、吸烟史、既往存在的孤立肾以及就诊时的症状性疾病。病理特征包括组织学亚型、核分级、肿瘤分期（2003年TNM）和肿瘤大小。采用Kaplan-Meier方法估计癌症特异性生存率。
与接受RN治疗的患者相比（6例或38% 对0例，p<0.001），接受NSS治疗的患者中孤立肾的比例更高。在102例因多个肿瘤接受RN治疗的患者中，12例死于RCC，中位死亡时间为3.3年（范围3个月至9.5年）。5年时的估计癌症特异性生存率为90.1%。5例患者在RN治疗后中位8.1年（范围3个月至14年）出现异时性对侧复发。16例接受NSS治疗的患者中有2例分别在NSS治疗后6年和11年死于RCC，5年时癌症特异性生存率为100%。2例患者分别在NSS治疗后1.7年和2.8年出现局部肾复发，1例患者在NSS治疗后7个月发现异时性对侧肾肿瘤。在102例接受RN治疗的患者中，63例（62%）和16例接受NSS治疗的患者中有9例（56%）至少有1个透明细胞RCC。在102例接受RN治疗的患者中，23例（23%）只有1个肿瘤是RCC，其余为良性，这表明这些患者是NSS的潜在候选者。
因多个同侧肾肿瘤（其中至少有1个是RCC）接受RN或NSS治疗的患者具有良好的癌症特异性生存率。散发性多灶性病变患者的异时性对侧复发率约为5%。如果卫星病灶是良性的，计划性NSS可能不应被放弃。
