Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
J Urol. 2010 Apr;183(4):1317-23. doi: 10.1016/j.juro.2009.12.030. Epub 2010 Feb 19.
Radical nephrectomy has traditionally been preferred to partial nephrectomy in patients with localized renal cell cancer because of its simplicity and established cancer control. Recent data suggest that these patients have significant competing risks of death, some of which may be increased by chronic renal insufficiency. Therefore, we compared overall survival, cancer specific survival and cardiac specific survival in patients undergoing partial or radical nephrectomy for cT1b tumors.
From 1999 to 2006, 1,004 patients with renal masses between 4 and 7 cm underwent extirpative surgery, partial nephrectomy (524) or radical nephrectomy (480). We generated a propensity model based on preoperative patient characteristics, and then modeled survival with the additional variables of pathological stage and new baseline renal function.
On multivariate analysis cancer specific survival was equivalent for patients treated with partial nephrectomy or radical nephrectomy. Those patients undergoing radical nephrectomy lost significantly more renal function than those undergoing partial nephrectomy. The average excess loss of renal function observed with radical nephrectomy was associated with a 25% (95% CI 3-73) increased risk of cardiac death and 17% (95% CI 12-27) increased risk of death from any cause on multivariate analysis.
Partial nephrectomy offers cancer specific survival equivalent to that of radical nephrectomy and is technically feasible in at least 50% of patients with cT1b tumors. Preservation of renal function was significantly better in patients treated with partial nephrectomy. Postoperative renal insufficiency was a significant independent predictor of overall and cardiovascular specific survival, and efforts should be made to limit the renal function loss associated with surgery for localized renal masses.
由于其简单性和既定的癌症控制效果，传统上在患有局限性肾细胞癌的患者中，根治性肾切除术优于部分肾切除术。最近的数据表明，这些患者有明显的死亡竞争风险，其中一些可能因慢性肾功能不全而增加。因此，我们比较了接受部分或根治性肾切除术治疗 cT1b 肿瘤的患者的总生存率、癌症特异性生存率和心脏特异性生存率。
1999 年至 2006 年，1004 名肾肿块在 4 至 7 厘米之间的患者接受了切除术，部分肾切除术（524 例）或根治性肾切除术（480 例）。我们基于术前患者特征生成了一个倾向模型，然后使用病理分期和新的基线肾功能等附加变量来建模生存。
在多变量分析中，接受部分肾切除术或根治性肾切除术治疗的患者癌症特异性生存率相当。接受根治性肾切除术的患者比接受部分肾切除术的患者肾功能丧失更多。观察到的根治性肾切除术引起的平均肾功能过度丧失与心脏死亡风险增加 25%（95%CI 3-73）和多变量分析中任何原因死亡风险增加 17%（95%CI 12-27）相关。
部分肾切除术提供与根治性肾切除术相当的癌症特异性生存率，并且在至少 50%的 cT1b 肿瘤患者中技术上是可行的。接受部分肾切除术治疗的患者肾功能保存明显更好。术后肾功能不全是总生存率和心血管特异性生存率的显著独立预测因素，应努力限制与局限性肾肿块手术相关的肾功能损失。
