Becker F, Siemer S, Humke U, Hack M, Ziegler M, Stöckle M
Department of Urology and Paediatric Urology, University of Saarland, Germany.
Eur Urol. 2006 Feb;49(2):308-13. doi: 10.1016/j.eururo.2005.10.020. Epub 2005 Dec 9.
Our experiences with elective nephron-sparing surgery (NSS) for renal cell carcinoma (RCC) in a consecutive series of 216 patients are presented. Clinicopathological features and long-term oncological outcome is compared to patients treated with radical nephrectomy (RN).
Between 1975 and 2002, NSS was performed in 488 patients; 311 of these patients had elective indications. Renal cell carcinoma was found in 241/311 patients (77.5%). Long-term follow up data could be obtained in 216/311 patients. Cancer-specific survival was estimated using the Kaplan-Meier method. Cox's regression analysis and log-rank tests were used to evaluate independent predictive values of different clinicopathological features. Survival data of the 216 patients after NSS surgery were compared to 369 patients with small RCC treated with RN.
After a mean follow up of 66 months (median 64 months) 29 (13.4%) of 216 patients treated with NSS had died, 4 of them (1.8%) tumour-related. Tumour recurrence was detected in 12 patients (5.6%). 204 patients (94.4%) were free of tumour at last follow-up. Cancer specific survival rates at 5 and 10 years for patients treated with NSS (RN) were 97.8% (95.5%) and 95.8% (84.4%).
Elective NSS surgery provides optimal long-term outcome in patients with small localized RCC. Compared to RN, renal parenchyma is preserved without any disadvantage in survival rates. Consequently elective NSS should be accepted as gold standard for small renal tumours.
介绍我们对连续216例肾细胞癌（RCC）患者进行选择性保留肾单位手术（NSS）的经验。将其临床病理特征和长期肿瘤学结果与接受根治性肾切除术（RN）的患者进行比较。
1975年至2002年间，对488例患者实施了NSS；其中311例患者有选择性适应症。在241/311例患者（77.5%）中发现了肾细胞癌。可获得216/311例患者的长期随访数据。采用Kaplan-Meier法估计癌症特异性生存率。使用Cox回归分析和对数秩检验评估不同临床病理特征的独立预测价值。将216例NSS手术后患者的生存数据与369例接受RN治疗的小肾癌患者的生存数据进行比较。
平均随访66个月（中位数64个月）后，216例接受NSS治疗的患者中有29例（13.4%）死亡，其中4例（1.8%）与肿瘤相关。12例患者（5.6%）检测到肿瘤复发。在最后一次随访时，204例患者（94.4%）无肿瘤。接受NSS（RN）治疗的患者5年和10年的癌症特异性生存率分别为97.8%（95.5%）和95.8%（84.4%）。
选择性NSS手术为局限性小肾癌患者提供了最佳的长期预后。与RN相比，保留了肾实质，生存率没有任何劣势。因此，选择性NSS应被视为小肾肿瘤的金标准。
