对于4至7厘米之间适当选择的肾细胞癌，保留肾单位手术的结果与根治性肾切除术相似。

Nephron sparing surgery for appropriately selected renal cell carcinoma between 4 and 7 cm results in outcome similar to radical nephrectomy.

作者信息

Leibovich Bradley C, Blute Michael L, Cheville John C, Lohse Christine M, Weaver Amy L, Zincke Horst

机构信息

Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota 55905, USA.

出版信息

J Urol. 2004 Mar;171(3):1066-70. doi: 10.1097/01.ju.0000113274.40885.db.

DOI:10.1097/01.ju.0000113274.40885.db

PMID:14767272

Abstract

PURPOSE

We compared outcomes between patients treated with nephron sparing surgery (NSS) without imperative indications for renal preservation and radical nephrectomy (RN) for 4 to 7 cm renal cell carcinoma (RCC).

MATERIALS AND METHODS

We identified 91 patients treated with NSS and 841 patients treated with RN for 4 to 7 cm RCC between 1970 and 2000. Cancer specific, distant metastases-free and recurrence-free survivals were estimated using the Kaplan-Meier method.

RESULTS

Cancer specific survival rates at 5 years for patients treated with NSS and RN for 4 to 7 cm RCC were 98% and 86%, respectively. On univariate analysis patients treated with RN for 4 to 7 cm RCC were more likely to die of RCC compared to patients treated with NSS. However, after adjusting for features associated with death from RCC including stage, grade, histological tumor necrosis and histological subtype, this difference was no longer statistically significant (risk ratio 1.60, 95% CI 0.50-5.12, p = 0.430). Distant metastases-free survival rates at 5 years for patients treated with NSS and RN were 94% and 83%, respectively. On univariate analysis patients treated with RN were more likely to have tumors that metastasized compared to patients treated with NSS, although this difference was no longer significant after adjusting for the features listed previously (risk ratio 1.76, 95% CI 0.64-4.83, p = 0.273). Recurrence-free survival rates at 5 years for patients treated with NSS and RN were 94% and 98%, respectively. On univariate analysis patients treated with RN were less likely to have recurrence compared to patients treated with NSS (risk ratio 0.32, 95% CI 0.12-0.85, p = 0.022).

CONCLUSIONS

There were no statistically significant differences in cancer specific survival and distant metastases-free survival between patients treated with NSS and RN for 4 to 7 cm RCC after adjusting for important pathological features. NSS for 4 to 7 cm RCC results in excellent outcome in appropriately selected patients.

摘要

目的

我们比较了对4至7厘米肾细胞癌（RCC）进行无绝对肾保留指征的保留肾单位手术（NSS）治疗的患者与根治性肾切除术（RN）治疗的患者的预后。

材料与方法

我们确定了1970年至2000年间91例接受NSS治疗的患者和841例接受RN治疗的4至7厘米RCC患者。使用Kaplan-Meier方法估计癌症特异性、无远处转移和无复发生存率。

结果

4至7厘米RCC患者接受NSS和RN治疗的5年癌症特异性生存率分别为98%和86%。单因素分析显示，4至7厘米RCC接受RN治疗的患者比接受NSS治疗的患者更有可能死于RCC。然而，在对与RCC死亡相关的特征（包括分期、分级、组织学肿瘤坏死和组织学亚型）进行调整后，这种差异不再具有统计学意义（风险比1.60，95%可信区间0.50-5.12，p = 0.430）。接受NSS和RN治疗的患者5年无远处转移生存率分别为94%和83%。单因素分析显示，与接受NSS治疗的患者相比，接受RN治疗的患者肿瘤更有可能发生转移，尽管在对上述特征进行调整后这种差异不再显著（风险比1.76，95%可信区间0.64-4.83，p = 0.273）。接受NSS和RN治疗的患者5年无复发生存率分别为94%和98%。单因素分析显示，与接受NSS治疗的患者相比，接受RN治疗的患者复发可能性较小（风险比0.32，95%可信区间0.12-0.85，p = 0.022）。