Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA.
BJU Int. 2010 Nov;106(10):1484-7. doi: 10.1111/j.1464-410X.2010.09405.x.
To examine our institutional experience in patients treated with partial nephrectomy (PN) for renal cortical tumours (RCTs) of ≥ 7 cm, as PN is an accepted surgical approach for appropriate RCTs of < 7 cm but there are limited data on the use of PN for larger tumours.
After Institutional Review Board approval, we examined our prospectively collected surgical database for patients treated with PN for RCTs of ≥ 7 cm between 1989 and 2008. Pertinent demographic, clinical, surgical and pathological data were reviewed.
In all, 34 patients (37 renal units) were identified for analysis with a median (interquartile range, IQR) age of 63 (52-71) years, median (IQR) tumour size of 7.5 (7.2-9.0) cm with the largest tumour being 19 cm. In 31 renal units (28 patients, 84%) carcinoma was evident, with 16 renal units (43%) having conventional clear cell carcinoma, followed by papillary in eight renal units (21%). Currently, 20 of these 28 patients (71%) are disease free, three are alive with metastatic disease (two had known preoperative metastatic disease), three died from disease and two died from other causes. The median (IQR) preoperative estimated glomerular filtration rate was 65 (55-73) mL/min/1.73 m(2) , compared with 55 (47-74) mL/min/1.73 m(2) after PN (P= 0.003, paired Student's t-test).
Our findings suggest that PN for RCTs of ≥ 7 cm can be safely performed and provide effective tumour control for selected patients. PN should be considered for patients with appropriate tumours, solitary kidneys or pre-existing renal insufficiency.
检查我们在接受部分肾切除术（PN）治疗的肾皮质肿瘤（RCTs）≥7cm 患者中的机构经验，因为 PN 是一种公认的手术方法，适用于<7cm 的适当 RCTs，但对于较大肿瘤的 PN 使用数据有限。
在机构审查委员会批准后，我们检查了我们在 1989 年至 2008 年间使用 PN 治疗≥7cm RCTs 的前瞻性收集的手术数据库。回顾了相关的人口统计学、临床、手术和病理数据。
共分析了 34 例（37 个肾脏单位）患者，中位（四分位距，IQR）年龄为 63（52-71）岁，中位（IQR）肿瘤大小为 7.5（7.2-9.0）cm，最大肿瘤为 19cm。在 31 个肾脏单位（28 例患者，84%）中可见癌，16 个肾脏单位（43%）有常规透明细胞癌，其次是 8 个肾脏单位（21%）的乳头状癌。目前，28 例患者中有 20 例（71%）无疾病，3 例有转移性疾病（2 例术前已知转移性疾病），3 例死于疾病，2 例死于其他原因。中位（IQR）术前估算肾小球滤过率为 65（55-73）mL/min/1.73m²，而 PN 后为 55（47-74）mL/min/1.73m²（P=0.003，配对学生 t 检验）。
我们的研究结果表明，PN 可安全用于治疗≥7cm 的 RCTs，并为选定的患者提供有效的肿瘤控制。对于有适当肿瘤、单肾或存在预先存在的肾功能不全的患者，应考虑 PN。
