Department of Urology, Mondor Hospital, Paris, France.
BJU Int. 2009 Dec;104(11):1714-7. doi: 10.1111/j.1464-410X.2009.08662.x. Epub 2009 Jul 16.
To compare the oncological outcome of patients with pT3 renal tumours treated either by laparoscopic radical nephrectomy (LRN) or open RN (ORN).
In a retrospective review of a multi-institutional database, we identified 1003 patients with a T3N0M0 renal tumour and with no vena caval invasion. Sixty-five patients treated by LRN were matched with up to four patients treated by ORN. Exact matches were made for age, gender, tumour size, perirenal fat invasion, renal vein invasion, and histological subtype. Following the matching process there were 44 patients treated by LRN and 135 by ORN. Qualitative and continuous variables were compared using chi-square and independent-sample t-tests, respectively. Differences in survival were compared using the Kaplan-Meier method. A Cox regression model was used to test the effect of variables on survival.
The two groups were comparable for age (P = 0.4), gender, tumour size (P = 0.4), tumour grade (P = 0.25) and histological subtype (P = 0.45). The mean follow-up was longer in the ORN group (55 vs 28 months, P < 0.001). There was no difference in survival between the ORN and LRN groups in the whole T3 population (P = 0.7), in those with perirenal fat invasion (P = 0.9), or in the subset with renal vein invasion (P = 0.31). In univariate analysis, the only predictor for death from cancer was tumour grade (P = 0.05). In multivariate analysis, no variable was significantly associated with cancer survival.
LRN has no adverse effect on cancer survival compared to ORN in patients with microscopic T3 renal cancer. Additional prospective evaluation is warranted.
比较接受腹腔镜根治性肾切除术（LRN）或开放性肾切除术（ORN）治疗的 pT3 肾肿瘤患者的肿瘤学结果。
在对多机构数据库的回顾性研究中，我们确定了 1003 例 T3N0M0 肾肿瘤且无下腔静脉侵犯的患者。对 65 例接受 LRN 治疗的患者进行了多达 4 例接受 ORN 治疗的患者的匹配。对年龄、性别、肿瘤大小、肾周脂肪浸润、肾静脉浸润和组织学亚型进行精确匹配。匹配后，有 44 例接受 LRN 治疗，135 例接受 ORN 治疗。使用卡方检验和独立样本 t 检验分别比较定性和连续变量。使用 Kaplan-Meier 方法比较生存差异。使用 Cox 回归模型检验变量对生存的影响。
两组患者的年龄（P = 0.4）、性别、肿瘤大小（P = 0.4）、肿瘤分级（P = 0.25）和组织学亚型（P = 0.45）相似。ORN 组的平均随访时间较长（55 比 28 个月，P < 0.001）。在整个 T3 人群中，ORN 和 LRN 组之间的生存率没有差异（P = 0.7），在肾周脂肪浸润患者中（P = 0.9），或在肾静脉侵犯患者亚组中（P = 0.31）也没有差异。单因素分析显示，唯一与癌症死亡相关的预测因素是肿瘤分级（P = 0.05）。多因素分析显示，没有变量与癌症生存显著相关。
与 ORN 相比，LRN 对显微镜下 T3 肾肿瘤患者的癌症生存率没有不良影响。需要进一步的前瞻性评估。
