Antonelli Alessandro, Cozzoli Alberto, Nicolai Maria, Zani Danilo, Zanotelli Tiziano, Perucchini Laura, Cunico Sergio Cosciani, Simeone Claudio
Department of Urology, University of Brescia, Brescia, Italy.
Eur Urol. 2008 Apr;53(4):803-9. doi: 10.1016/j.eururo.2007.11.007. Epub 2007 Nov 20.
To compare the oncologic outcomes of nephron-sparing surgery versus radical nephrectomy in intracapsular renal cell carcinoma (RCC) up to 7 cm by reviewing surgical experience retrospectively.
Data from 1290 consecutive patients who had surgery for RCC have been stored in a dedicated database since 1983. We selected and reviewed those related to disease-free patients who had been treated for unilateral pT1a/pT1b pN0/Nx M0 carcinomas up to 7 cm and later followed for a minimum of 12 mo.
A total of 642 patients with mean follow-up of 72.9 mo were selected; 313 had been treated for tumours <4 cm in diameter (176 nephron-sparing surgery, 137 nephrectomy), whereas 329 had been treated for tumours measuring > or =4 cm (52 nephron-sparing surgery, 277 nephrectomy). The comparison between tumours <4 cm or > or =4 cm in diameter showed worse progression and disease-free survival rates for the latter, but the type of surgery (nephron-sparing or radical) seemed to have no significant impact.
Conservative management can be cautiously suggested for RCC up to 7 cm because the worsening of prognosis as diameter increases shows no statistical differences for either nephron-sparing or radical surgery. The agreement of our results with those of similar studies available in the literature may suggest designing a prospective study to compare conservative and more radical surgery in the management of RCC up to 7 cm.
通过回顾手术经验，比较保留肾单位手术与根治性肾切除术治疗直径达7cm的包膜内肾细胞癌（RCC）的肿瘤学结局。
自1983年起，1290例接受RCC手术的连续患者的数据已存储在一个专用数据库中。我们选择并回顾了那些与无病患者相关的数据，这些患者接受了直径达7cm的单侧pT1a/pT1b pN0/Nx M0癌的治疗，随后至少随访12个月。
共选择了642例患者，平均随访72.9个月；313例患者的肿瘤直径<4cm（176例行保留肾单位手术，137例行肾切除术），而329例患者的肿瘤直径≥4cm（52例行保留肾单位手术，277例行肾切除术）。直径<4cm或≥4cm的肿瘤之间的比较显示，后者的进展和无病生存率较差，但手术类型（保留肾单位或根治性）似乎没有显著影响。
对于直径达7cm的RCC，可以谨慎地建议采用保守治疗，因为随着直径增加预后恶化在保留肾单位手术或根治性手术中均无统计学差异。我们的结果与文献中类似研究的结果一致，这可能表明需要设计一项前瞻性研究来比较在直径达7cm的RCC治疗中保守手术和更激进手术的效果。
