Krambeck Amy E, Leibovich Bradley C, Lohse Christine M, Kwon Eugene D, Zincke Horst, Blute Michael L
Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota 55905, USA.
J Urol. 2006 Nov;176(5):1990-5; discussion 1995. doi: 10.1016/j.juro.2006.07.015.
Studies have demonstrated increased time to progression when cytoreductive nephrectomy is performed for metastatic renal cell carcinoma. We evaluated the role of nephron sparing surgery in these patients.
We selected all patients with pM1 renal cell carcinoma treated with nephron sparing surgery or radical nephrectomy, and all patients with pM0 renal cell carcinoma undergoing nephron sparing surgery for solitary kidney from 1970 to 2002 from the Mayo Clinic Nephrectomy Registry.
We identified 16 patients who underwent nephron sparing surgery for pM1 renal cell carcinoma. Solitary kidney was present in 12, 3 had bilateral synchronous disease and 1 had elective nephron sparing surgery. Cancer specific survival rates at 1, 3 and 5 years were 81%, 49% and 49%, respectively. We identified 404 patients who underwent radical nephrectomy for pM1 renal cell carcinoma. Cancer specific survival rates at 1, 3 and 5 years were 51%, 21% and 13%, respectively. The pM1 nephron sparing surgery for solitary kidney cases were more likely to have early (33% vs 10%, p = 0.009) or late (50% vs 19%, p = 0.018) complications compared with pM1 radical nephrectomy cases. There were no significant differences in early (p = 0.475) or late (p = 0.350) complications between pM1 nephron sparing surgery cases and 139 pM0 nephron sparing surgery cases.
Cancer specific survival rates in pM1 nephron sparing surgery cases were comparable to pM1 radical nephrectomy cases. Although there were differences in early and late complications between the pM1 nephron sparing surgery and pM1 radical nephrectomy groups, there were no differences when compared with imperative pM0 nephron sparing surgery cases. This study demonstrates that nephron sparing surgery can achieve adequate cytoreductive therapy while preserving renal function, with postoperative complication rates similar to those of pM0 nephron sparing surgery cases.
研究表明，转移性肾细胞癌患者行减瘤性肾切除术后疾病进展时间延长。我们评估了保留肾单位手术在这些患者中的作用。
我们从梅奥诊所肾切除术登记处选取了1970年至2002年间所有接受保留肾单位手术或根治性肾切除术治疗的pM1期肾细胞癌患者，以及所有因孤立肾而行保留肾单位手术的pM0期肾细胞癌患者。
我们确定了16例接受保留肾单位手术治疗pM1期肾细胞癌的患者。其中12例为孤立肾，3例为双侧同步病变，1例为选择性保留肾单位手术。1年、3年和5年的癌症特异性生存率分别为81%、49%和49%。我们确定了404例接受根治性肾切除术治疗pM1期肾细胞癌的患者。1年、3年和5年的癌症特异性生存率分别为51%、21%和13%。与pM1期根治性肾切除术病例相比，pM1期孤立肾病例行保留肾单位手术更易发生早期（33%对10%，p = 0.009）或晚期（50%对19%，p = 0.018）并发症。pM1期保留肾单位手术病例与139例pM0期保留肾单位手术病例在早期（p = 0.475）或晚期（p = 0.350）并发症方面无显著差异。
pM1期保留肾单位手术病例的癌症特异性生存率与pM1期根治性肾切除术病例相当。虽然pM1期保留肾单位手术组与pM1期根治性肾切除术组在早期和晚期并发症方面存在差异，但与必要的pM0期保留肾单位手术病例相比无差异。本研究表明，保留肾单位手术在保留肾功能的同时可实现充分的减瘤治疗，术后并发症发生率与pM0期保留肾单位手术病例相似。
