Glickman Urologic and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue,Cleveland, OH 44195, USA.
Eur Urol. 2010 Aug;58(2):293-8. doi: 10.1016/j.eururo.2010.04.033. Epub 2010 May 18.
Partial nephrectomy (PN) has been associated with improved overall survival (OS) in select cohorts with localised renal masses when compared to radical nephrectomy (RN). The driving forces behind these differences have been difficult to elucidate given the heterogeneity of previously compared cohorts.
Compare OS in a subset of patients with unanticipated benign renal masses to minimise the confounding effect of cancer.
DESIGN, SETTING, AND PARTICIPANTS: We retrospectively evaluated 2608 consecutive clinical T1 enhancing renal masses that were treated with extirpative surgery at our institution between 1999 and 2006. Of these, 499 tumours (19%) were found to be benign on final pathology. Preoperative data and renal functional data were used to generate a propensity model that was then plugged into a multivariate model of survival. Median follow-up for the entire cohort was 50 mo (interquartile range [IQR]: 32-73).
All patients underwent PN or RN.
We measured OS and cardiac-specific survival.
Five-year OS estimates for the PN (n=388) and RN (n=111) cohorts were 95% (95% confidence interval [CI], 93-98) versus 83% (95% CI, 74-90), respectively (P<0.0001). On multivariate analysis, controlling for both comorbidity and age, RN was associated with a 2.5-fold increased risk of death compared to PN (hazard ratio [HR]: 2.5; 95% CI, 1.3-5.1). Postoperative estimated glomerular filtration rate (eGFR) was also an independent predictor of OS and cardiac-specific survival (HR: 0.97; 95% CI, 0.95-0.99 and HR: 0.96; 95% CI, 0.93-0.99, respectively). The retrospective nature of this analysis limits the strength of the conclusions.
PN was associated with better OS when compared to RN in patients with unanticipated benign tumours. This observed survival advantage appears partly to be the result of better preservation of eGFR, but other kidney functions or unmeasured factors may also play a role. These data indicate that PN should be aggressively pursued in any patient where PN is technically feasible.
与根治性肾切除术（RN）相比，在选择局部肾肿块的患者中，部分肾切除术（PN）与改善总体生存率（OS）相关。由于之前比较的队列存在异质性，因此很难阐明导致这些差异的驱动因素。
在一组意外良性肾肿块患者中比较 OS，以最大程度减少癌症的混杂影响。
设计、设置和参与者：我们回顾性评估了 1999 年至 2006 年间在我们机构接受切除术治疗的 2608 例连续临床 T1 增强肾肿块。其中，499 个肿瘤（19%）在最终病理检查中被发现为良性。使用术前数据和肾功能数据生成倾向模型，然后将其插入生存的多变量模型中。整个队列的中位随访时间为 50 个月（四分位距 [IQR]：32-73）。
所有患者均接受 PN 或 RN。
我们测量了 OS 和心脏特异性生存率。
PN（n=388）和 RN（n=111）队列的 5 年 OS 估计值分别为 95%（95%置信区间 [CI]，93-98）和 83%（95% CI，74-90），差异有统计学意义（P<0.0001）。多变量分析显示，在控制合并症和年龄后，与 PN 相比，RN 与死亡风险增加 2.5 倍相关（风险比 [HR]：2.5；95%CI，1.3-5.1）。术后估算肾小球滤过率（eGFR）也是 OS 和心脏特异性生存率的独立预测因素（HR：0.97；95%CI，0.95-0.99 和 HR：0.96；95%CI，0.93-0.99）。该分析的回顾性限制了结论的强度。
与 RN 相比，在意外良性肿瘤患者中，PN 与更好的 OS 相关。这种观察到的生存优势部分归因于 eGFR 的更好保留，但其他肾功能或未测量的因素也可能发挥作用。这些数据表明，只要 PN 在技术上可行，就应积极采用 PN。
