Department of Urology, Mayo Clinic, Rochester, MN, USA.
Eur Urol. 2013 Oct;64(4):600-6. doi: 10.1016/j.eururo.2012.12.023. Epub 2012 Dec 25.
Although partial nephrectomy (PN) has been associated with improved renal function compared with radical nephrectomy (RN) for renal cell carcinoma, the impact on overall survival (OS) remains controversial.
To evaluate comparative OS and renal function in patients following PN and RN for a renal mass where malignancy was not a confounding factor.
DESIGN, SETTING, AND PARTICIPANTS: Using the Mayo Clinic Nephrectomy Registry, we retrospectively identified 442 patients with unilateral sporadic benign renal masses treated surgically with PN or RN between 1980 and 2008.
The primary outcome measures were OS and the incidence of new-onset stage IV chronic kidney disease (CKD), determined using the Kaplan-Meier method. Cox models were used to test the association of nephrectomy type with these outcomes.
Overall, 206 and 236 patients with benign renal masses were surgically treated with RN and PN, respectively. Patients who underwent RN were older (median age: 67 vs 64 yr; p=0.02) and had larger tumors (median size: 5.0 vs 2.7 cm; p<0.001). Median follow-up for patients still alive at last follow-up was 8.3 yr (range: 0.1-27.9 yr). Estimated OS (95% confidence interval [CI]) rates at 10 and 15 yr were 69% (62-76%) and 53% (45-62%) for RN compared with 80% (73-87%) and 74% (65-83%) following PN (p=0.032). After adjusting for covariates of interest, patients treated with RN were significantly more likely to die from any cause (hazard ratio [HR]: 1.75; 95% CI, 1.08-2.83; p=0.023) or develop stage IV CKD (HR: 4.23; 95% CI, 1.80-9.93; p<0.001) compared with patients who underwent PN. Limitations include the retrospective design, selection bias for surgical approach, and referral bias to a tertiary care facility.
Our data suggest that PN may confer a clinical benefit for improved renal function and better OS compared with RN after excluding the confounding effect of malignancy.
尽管与根治性肾切除术（RN）相比，部分肾切除术（PN）与改善肾功能相关，但对总生存（OS）的影响仍存在争议。
评估 PN 和 RN 治疗单侧散发性良性肾肿瘤患者的 OS 和肾功能，其中恶性肿瘤不是混杂因素。
设计、地点和参与者：使用梅奥诊所肾切除术登记处，我们回顾性地确定了 1980 年至 2008 年间接受 PN 或 RN 手术治疗的 442 例单侧散发性良性肾肿块患者。
主要结果指标是 OS 和新发 IV 期慢性肾脏病（CKD）的发生率，采用 Kaplan-Meier 法确定。Cox 模型用于检验肾切除术类型与这些结果的相关性。
总体而言，206 例和 236 例良性肾肿块患者分别接受 RN 和 PN 手术治疗。接受 RN 的患者年龄更大（中位年龄：67 岁比 64 岁；p=0.02），肿瘤更大（中位大小：5.0 厘米比 2.7 厘米；p<0.001）。在最后一次随访时仍存活的患者的中位随访时间为 8.3 年（范围：0.1-27.9 年）。RN 组 10 年和 15 年的估计 OS（95%置信区间[CI]）率分别为 69%（62%-76%）和 53%（45%-62%），而 PN 组分别为 80%（73%-87%）和 74%（65%-83%）（p=0.032）。调整了感兴趣的混杂因素后，接受 RN 治疗的患者死于任何原因的风险显著更高（风险比[HR]：1.75；95%CI，1.08-2.83；p=0.023）或发生 IV 期 CKD 的风险更高（HR：4.23；95%CI，1.80-9.93；p<0.001），而接受 PN 治疗的患者。局限性包括回顾性设计、手术方法的选择偏倚和向三级保健机构的转诊偏倚。
我们的数据表明，在排除恶性肿瘤的混杂影响后，PN 可能在改善肾功能和提高 OS 方面带来临床获益。
