Russo Paul
Department of Surgery, Urology Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.
Curr Urol Rep. 2008 Jan;9(1):15-21. doi: 10.1007/s11934-008-0005-4.
Renal cortical tumors (RCT) are a family of neoplasms with diverse histology and metastatic potentials. Conventional clear cell tumors account for 54% of all RCT and 90% of those that metastasize. Liberal use of abdominal imaging detects 70% of RCT incidentally and at a small size (< 4 cm in diameter). Emerging evidence strongly favors partial nephrectomy (PN) as the primary treatment when technically possible for tumors 7 cm or smaller. This approach provides local tumor control equivalent to radical nephrectomy (RN) and prevents or delays chronic kidney disease (CKD) onset. CKD is present in 26% of apparently well patients with such small renal tumors and is an independent risk factor for cardiovascular disease, hospitalization, and death. The likelihood of freedom from an estimated glomerular filtration rate lower than 45 mL/min/1.73m2, a level of significant CKD, is 95% after PN, but only 64% after RN. RN should be reserved for patients with massive renal tumors in whom PN is not an option. Increased training in PN and its wider application is essential.
肾皮质肿瘤（RCT）是一组具有不同组织学和转移潜能的肿瘤。传统的透明细胞肿瘤占所有肾皮质肿瘤的54%，占发生转移的肾皮质肿瘤的90%。腹部影像学检查的广泛应用可偶然发现70%的肾皮质肿瘤，且肿瘤体积较小（直径<4cm）。新出现的证据强烈支持，对于直径7cm及以下的肿瘤，在技术可行时，首选部分肾切除术（PN）作为主要治疗方法。这种方法提供的局部肿瘤控制效果与根治性肾切除术（RN）相当，并可预防或延缓慢性肾脏病（CKD）的发生。在患有此类小肾肿瘤的表面健康患者中，26%存在慢性肾脏病，慢性肾脏病是心血管疾病、住院和死亡的独立危险因素。接受部分肾切除术后，估计肾小球滤过率低于45mL/min/1.73m²（这是慢性肾脏病的一个显著水平）的可能性为95%，而接受根治性肾切除术后仅为64%。根治性肾切除术应仅用于无法进行部分肾切除术的巨大肾肿瘤患者。加强部分肾切除术的培训并扩大其应用至关重要。
