Vanderbilt University, Nashville, Tennessee, USA.
J Urol. 2013 Aug;190(2):470-4. doi: 10.1016/j.juro.2013.03.028. Epub 2013 Mar 14.
Followup is limited in patients with a solitary kidney who undergo partial nephrectomy. We evaluated overall, cancer specific and recurrence-free survival, and renal function in patients 5 years or greater after open partial nephrectomy.
We retrospectively reviewed the Cleveland Clinic kidney cancer database, including only patients with a solitary kidney treated with open partial nephrectomy 5 or more years ago (from 1980 to June 2006) who had 6 months or more of followup. Survival and recurrence analyses were calculated using a Cox proportional hazards model. Results are shown as Kaplan-Meier survival curves. Linear regression analysis was done to assess postoperative renal function.
A total of 282 patients fit our study inclusion criteria (mean followup 175 months), of whom 233 underwent open partial nephrectomy 10 or more years ago. Actual overall survival was 78.5% and 59.5% at 5 and 10 years, respectively. The average estimated glomerular filtration rate at 5 years or greater and 10 years or greater since open partial nephrectomy was 35.1 and 34.5 ml/minute/1.73 m(2) in 89.7% and 89.6%, respectively, of patients with stage 3 or greater chronic kidney disease. Eight survivors were on intermittent hemodialysis 5 years or more postoperatively, including 5 at 10 years or more. There were 76 recurrences for a calculated 5 and 10-year recurrence-free survival rate of 72% (95% CI 66-879) and 63% (95% CI 57-71), respectively.
Open partial nephrectomy in the solitary kidney provides reliable long-term oncological control at 5 and 10 years. Predicted and actual outcomes correspond well. Although most patients have chronic kidney disease postoperatively, it appears stable with minimal progression to dialysis.
对于接受部分肾切除术的单肾患者，随访受到限制。我们评估了 5 年或以上接受开放性部分肾切除术的患者的总体生存率、癌症特异性生存率和无复发生存率以及肾功能。
我们回顾性地审查了克利夫兰诊所的肾癌数据库，其中仅包括 5 年或以上前（1980 年至 2006 年 6 月）接受开放性部分肾切除术治疗且随访时间至少 6 个月的单肾患者。使用 Cox 比例风险模型计算生存和复发分析。结果以 Kaplan-Meier 生存曲线表示。进行线性回归分析以评估术后肾功能。
共有 282 名患者符合我们的研究纳入标准（平均随访 175 个月），其中 233 名患者在 10 年或以上前接受了开放性部分肾切除术。实际的总体生存率分别为 5 年和 10 年的 78.5%和 59.5%。89.7%和 89.6%的 3 期或更严重慢性肾脏病患者，在 5 年或以上和 10 年或以上的时间点，估计肾小球滤过率分别为 35.1 和 34.5ml/min/1.73m(2)。8 名幸存者在术后 5 年或以上需要间歇性血液透析，其中 5 名在 10 年或以上。有 76 例复发，计算得出 5 年和 10 年无复发生存率分别为 72%（95%CI 66-879）和 63%（95%CI 57-71）。
单肾开放性部分肾切除术可提供可靠的长期肿瘤控制，5 年和 10 年的结果均令人满意。预测结果和实际结果吻合良好。尽管大多数患者术后存在慢性肾脏病，但肾功能似乎稳定，进展至透析的情况很少。
