Department of Urology, Mayo Clinic, Rochester, Minnesota 55901, USA.
J Urol. 2010 Mar;183(3):903-8. doi: 10.1016/j.juro.2009.11.037. Epub 2010 Jan 18.
Partial nephrectomy for stage T1 renal cell carcinoma is oncologically efficacious and safe, and may have survival advantages. We describe our experience with partial nephrectomy for T2 or greater renal cell cancer.
Between 1970 and 2008 approximately 2,300 partial nephrectomies were done at our institution, including 69 for sporadic unilateral advanced stage tumors (pT2 in 32, pT3a in 28 and pT3b in 9). We reviewed outcomes in these patients compared to those in 207 treated with radical nephrectomy matched 3:1 for stage, tumor size, baseline renal function, age and gender.
The risk of cancer specific (HR 0.80, 95% CI 0.43-1.50, p = 0.489) and overall (HR 1.11, 95% CI 0.72-1.71, p = 0.642) death was similar for partial nephrectomy. At a median of 3.2 years of followup 15 patients (22%) with partial nephrectomy had metastatic disease vs 69 (33%) with radical nephrectomy (HR 0.74, 95% CI 0.42-1.29, p = 0.29). Four patients (6%) with partial nephrectomy had isolated local recurrence vs 7 (3%) with radical nephrectomy (HR 2.11, 95% CI 0.62-7.22, p = 0.234). In the partial nephrectomy group 12 (17%) and 2 cases (3%) were complicated by urine leak and retroperitoneal bleeding requiring intervention, respectively. The median serum creatinine increase was 9.5% (IQR 0-22) vs 33% (IQR 20-47) for partial vs radical nephrectomy (p <0.001).
Partial nephrectomy for T2 or greater renal cell carcinoma preserves renal function and appears to achieve oncological outcomes similar to those of radical nephrectomy. The role of partial nephrectomy in patients with T2-3 tumors and a normal contralateral kidney deserves further consideration and study.
对于 T1 期肾细胞癌，部分肾切除术在肿瘤学上是有效的且安全的，并且可能具有生存优势。我们描述了我们在 T2 或更大的肾细胞癌患者中进行部分肾切除术的经验。
在我们的机构中，1970 年至 2008 年期间进行了大约 2300 例部分肾切除术，其中 69 例为单侧散发性晚期肿瘤（pT2 32 例，pT3a 28 例，pT3b 9 例）。我们比较了这些患者与 207 例接受根治性肾切除术的患者的结果，这些患者按肿瘤分期、肿瘤大小、基线肾功能、年龄和性别进行了 3:1 的匹配。
部分肾切除术组癌症特异性（HR 0.80，95%CI 0.43-1.50，p = 0.489）和总死亡率（HR 1.11，95%CI 0.72-1.71，p = 0.642）与根治性肾切除术相似。在中位随访 3.2 年时，15 例（22%）接受部分肾切除术的患者发生转移疾病，而 69 例（33%）接受根治性肾切除术的患者发生转移疾病（HR 0.74，95%CI 0.42-1.29，p = 0.29）。4 例（6%）接受部分肾切除术的患者发生孤立性局部复发，而 7 例（3%）接受根治性肾切除术的患者发生孤立性局部复发（HR 2.11，95%CI 0.62-7.22，p = 0.234）。在部分肾切除术组中，有 12 例（17%）和 2 例（3%）分别因尿漏和腹膜后出血需要介入治疗而出现并发症。部分肾切除术组血清肌酐升高中位数为 9.5%（IQR 0-22），根治性肾切除术组为 33%（IQR 20-47）（p <0.001）。
对于 T2 或更大的肾细胞癌，部分肾切除术保留了肾功能，并且似乎可以达到与根治性肾切除术相似的肿瘤学结果。部分肾切除术在 T2-3 期肿瘤且对侧肾脏正常的患者中的作用值得进一步考虑和研究。
