Department of Urologic Oncology Biostatistics, Fox Chase Cancer Center, Philadelphia, PA, USA.
BJU Int. 2012 May;109(10):1450-6. doi: 10.1111/j.1464-410X.2011.10608.x. Epub 2012 Jan 5.
What's known on the subject? and What does the study add? Partial nephrectomy for the pT1 renal mass has demonstrated acceptable oncological outcomes in addition to improved overall long-term survival when compared with radical nephrectomy. Previous reports for lesions ≥ 7 cm have shown mixed data concerning oncological outcomes and technological success. We demonstrate that partial nephrectomy for renal masses ≥ 7 cm has acceptable oncological, technical, and functional outcomes. As such, partial nephrectomy should be a surgical option when feasible regardless of tumour size. Study Type - Therapy (case series) Level of Evidence 4.
To present outcomes for patients with renal masses ≥ 7 cm in size who are treated with partial nephrectomy (PN) at our institution and to summarize the cumulative published experience.
We reviewed our prospectively maintained institutional kidney cancer database and identified patients undergoing PN for tumours >7 cm in size. Technical, oncological and renal functional data were analyzed and compared with the existing published experience of PNs for tumours >7 cm in size.
In total, 46 patients with 49 renal tumours >7 cm in size who underwent PN were identified. With a median (range) follow-up of 13.1 (0.2-170.0) months, there were 16 complications, including four (8.2%) blood transfusions and six (12.2%) urinary fistulae. The 5- and 10-year overall and renal cell carcinoma (RCC)-specific survivals were 94.5% and 70.9%. There were five (10.9%) patients who had an upward migration in their chronic kidney disease status after PN. There were six previous series totalling 280 tumours encompassing the published experience of PN for tumours >7 cm in size. The incidence of urinary fistulae and postoperative haemorrhage, respectively, was in the range 3.3-18.8% and 0-3%. Although oncological outcomes showed cancer-specific survival in the range 66-97.0%, series matching PN and RN in patients with T2 RCC show equivalency in RCC-specific and overall survivals. When reported, PN for tumours >7 cm in size was associated with better renal functional preservation.
The findings of the present study show that PN can safely be performed in tumours ≥ 7 cm in size with acceptable technical, oncological and functional outcomes. Further studies are warranted.
介绍我们机构治疗的肿瘤直径大于 7cm 的患者行部分肾切除术（PN）的结果，并总结已发表的经验。
我们回顾了我们前瞻性维护的机构肾癌数据库，并确定了接受肿瘤直径大于 7cm 的 PN 治疗的患者。分析了技术、肿瘤学和肾功能数据，并与肿瘤直径大于 7cm 的 PN 现有发表经验进行了比较。
总共确定了 46 名肿瘤直径大于 7cm 的患者，共 49 个肾脏肿瘤，中位（范围）随访时间为 13.1（0.2-170.0）个月，有 16 例并发症，包括 4 例（8.2%）输血和 6 例（12.2%）尿瘘。5 年和 10 年的总生存率和肾细胞癌（RCC）特异性生存率分别为 94.5%和 70.9%。有 5 名（10.9%）患者在 PN 后慢性肾脏病状态上升。有 6 个之前的系列，共 280 个肿瘤，涵盖了肿瘤直径大于 7cm 的 PN 发表经验。尿瘘和术后出血的发生率分别为 3.3-18.8%和 0-3%。尽管肿瘤学结果显示癌症特异性生存率在 66-97.0%之间，但在匹配 T2RCC 的 PN 和 RN 的系列中，RCC 特异性和总生存率相当。当报告时，肿瘤直径大于 7cm 的 PN 与更好的肾功能保留相关。
本研究的结果表明，PN 可以安全地用于肿瘤直径大于 7cm 的患者，具有可接受的技术、肿瘤学和功能结果。需要进一步的研究。
