Cancer Prognostics and Health Outcomes Unit, University of Montréal Health Center, Montreal, Quebec, Canada.
Urology. 2012 Aug;80(2):347-53. doi: 10.1016/j.urology.2012.04.043. Epub 2012 Jun 13.
To test whether cancer control outcomes justify the consideration of partial nephrectomy in patients with large tumors (Stage pT2 or greater) or high-grade tumors (Fuhrman grade III-IV) or lesions extending beyond the kidney (Stage pT3a).
We abstracted the data for 8847, 11 547, and 5232 patients with tumors >7 cm, Fuhrman grade III-IV, and Stage T3a from the Surveillance, Epidemiology, and End Results database, respectively. All were treated with either partial nephrectomy or radical nephrectomy from 1988 to 2008. The 2- and 5-year cancer-specific mortality rates were compared between the partial nephrectomy and radical nephrectomy groups after propensity score matching. Separate multivariate analyses were conducted within each subcohort and specifically quantified the effect of partial nephrectomy on cancer-specific mortality.
For each of the 3 examined groups, the patients treated with partial nephrectomy failed to demonstrate statistically significant cancer-specific mortality differences relative to radical nephrectomy patients. The hazard ratio for the tumors >7 cm, Fuhrman grade III-IV, and Stage pT3a was 0.67 (95% confidence interval 0.39-1.17, P = .2), 0.81 (95% confidence interval 0.58-1.12, P = .21), and 0.99 (95% confidence interval 0.61-1.61, P = 1.0).
Even in patients with adverse pathologic features, partial nephrectomy does not compromise cancer-specific mortality. This implies that when functional outcomes are considered in patients with high-risk features, the decision to perform partial nephrectomy should not depend on the stage or grade, but rather on the technical ability to remove the tumor with a negative margin and provide sufficient functional renal remnant.
检验在肿瘤较大（T2 期或以上）或高级别肿瘤（Fuhrman 分级 III-IV 级）或肿瘤超出肾脏范围（T3a 期）的患者中，采用部分肾切除术是否能获得更好的肿瘤控制效果。
我们从监测、流行病学和最终结果数据库中分别提取了 8847 例、11547 例和 5232 例肿瘤＞7cm、Fuhrman 分级 III-IV 级和 T3a 期的患者数据。所有患者均在 1988 年至 2008 年间接受了部分肾切除术或根治性肾切除术治疗。在倾向评分匹配后，比较了部分肾切除术和根治性肾切除术组患者的 2 年和 5 年癌症特异性死亡率。在每个亚组内进行了单独的多变量分析，并专门量化了部分肾切除术对癌症特异性死亡率的影响。
在所检查的 3 个组中，接受部分肾切除术的患者与接受根治性肾切除术的患者相比，癌症特异性死亡率没有统计学上的显著差异。肿瘤＞7cm、Fuhrman 分级 III-IV 级和 T3a 期的危险比分别为 0.67（95%置信区间 0.39-1.17，P=0.2）、0.81（95%置信区间 0.58-1.12，P=0.21）和 0.99（95%置信区间 0.61-1.61，P=1.0）。
即使在具有不良病理特征的患者中，部分肾切除术也不会影响癌症特异性死亡率。这意味着，当考虑具有高危特征的患者的功能结果时，是否进行部分肾切除术不应取决于肿瘤的分期或分级，而应取决于切除肿瘤并获得阴性切缘以及提供足够的功能性肾残留组织的技术能力。
