保肾手术与根治性肾切除术治疗 T1BN0M0 期肾细胞癌同样有效：基于人群的评估。

Nephron-sparing surgery is equally effective to radical nephrectomy for T1BN0M0 renal cell carcinoma: a population-based assessment.

机构信息

Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, Quebec, Canada.

出版信息

Urology. 2010 Feb;75(2):271-5. doi: 10.1016/j.urology.2009.04.098. Epub 2009 Dec 4.

DOI:10.1016/j.urology.2009.04.098

PMID:19962740

Abstract

OBJECTIVES

To test the effect of nephron-sparing surgery (NSS) vs radical nephrectomy (RN) on cancer-specific mortality (CSM) in patients with T1bN0M0 renal cell carcinoma (RCC) in a population-based cohort. To date, only few series from tertiary care centers supported the use of NSS for T1bN0M0 (range 4-7 cm) RCC.

METHODS

The Surveillance, Epidemiology, and End Results database allowed us to identify 275 NSS (5.3%) and 4866 RN (94.7%) patients treated for T1bN0M0 RCC between 1988 and 2004. Analyses matched for age, year of surgery, tumor size, and Fuhrman grade addressed the effect of nephrectomy type (NSS vs RN) on CSM.

RESULTS

Five years after surgery, the surviving proportions of NSS and RN patients matched for age, tumor size, and year of surgery were respectively 91.4 and 95.3% and 90.1 and 93.8% in the cohort, where additional matching for Fuhrman grade was performed. Neither of the matched analyses resulted in statistically significant CSM difference (P = .1 and .4) between NSS and RN. Similarly, competing-risks regression analyses based on both matching schemes also failed to reveal statistically significant CSM differences (P = .3 and .3).

CONCLUSIONS

Our study represents the largest and the only population-based analysis of cancer control efficacy of NSS vs RN in T1bN0M0 RCC. It indicates that NSS does provide equivalent cancer control relative to RN. In consequence, based on cancer control equivalence, NSS should be given equal consideration to RN in patients with T1bN0M0 lesions.

摘要

目的

在一项基于人群的队列研究中，检验保肾手术（NSS）与根治性肾切除术（RN）对 T1bN0M0 肾细胞癌（RCC）患者癌症特异性死亡率（CSM）的影响。迄今为止，仅有少数来自三级护理中心的系列研究支持对 T1bN0M0（范围为 4-7 cm）RCC 使用 NSS。

方法

监测、流行病学和最终结果数据库使我们能够识别出 1988 年至 2004 年间接受 T1bN0M0 RCC 治疗的 275 例 NSS（5.3%）和 4866 例 RN（94.7%）患者。对年龄、手术年份、肿瘤大小和 Fuhrman 分级进行匹配分析，以评估肾切除术类型（NSS 与 RN）对 CSM 的影响。

结果

在按年龄、肿瘤大小和手术年份进行匹配的队列中，术后 5 年，NSS 和 RN 患者的生存比例分别为 91.4%和 95.3%，而在进行 Fuhrman 分级额外匹配的队列中，分别为 90.1%和 93.8%。在这两种匹配分析中，均未发现 NSS 和 RN 之间 CSM 存在统计学差异（P =.1 和.4）。同样，基于两种匹配方案的竞争风险回归分析也未能揭示 CSM 存在统计学差异（P =.3 和.3）。