The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins School of Medicine, Baltimore, Maryland.
J Urol. 2013 Nov;190(5):1907-11. doi: 10.1016/j.juro.2013.06.014. Epub 2013 Jun 11.
We evaluated the early oncological end point of recurrence-free survival in patients with renal cell carcinoma up-staged from cT1 to pT3a after partial nephrectomy. We also aimed to establish preoperative factors associated with pathological tumor up-staging.
A prospective database of robotic partial nephrectomy cases performed at 5 academic centers was queried for patients who underwent surgery for a solitary cT1 renal mass. Patients with pT1-2 renal cell carcinoma were compared to those with pT3a tumors to determine the difference in recurrence-free survival. Preoperative factors associated with cT1 to pT3a up-staging were studied using multivariate logistic regression analysis.
A total of 1,096 patients underwent robotic partial nephrectomy for a cT1 renal mass. At final pathological evaluation 855 tumors (78.0%) were found to be renal cell carcinoma, of which 41 (4.8%) were up-staged to pT3a. The 24-month recurrence-free survival estimates for pT1-2 and pT3a tumors were 99.2% and 91.8%, respectively (p=0.003). Multivariate analysis revealed that a high vs low R.E.N.A.L. (radius, exophytic/endophytic, nearness to collecting system or sinus, anterior/posterior and location relative to polar lines) nephrometry score was associated with tumor up-staging (OR 2.97, 95% CI 1.20-7.35, p=0.02). On separate multivariate analysis increasing tumor diameter (OR 1.66, 95% CI 1.32-2.08, p<0.001) and hilar location (OR 2.83, 95% CI 1.43-5.61, p=0.003) were also associated with up-staging.
At short-term followup patients with renal cell carcinoma up-staged from cT1 to pT3a have reasonable oncological outcomes after partial nephrectomy. Factors associated with tumor up-staging include high tumor complexity, increasing tumor diameter and hilar location. Further studies are needed to determine the comparative efficacy of partial vs radical nephrectomy for small pT3a tumors.
我们评估了肾部分切除术治疗后 cT1 期肾细胞癌患者肿瘤 pT3a 分期的无复发生存的早期肿瘤学终点。我们还旨在确定与病理肿瘤分期相关的术前因素。
对 5 个学术中心的机器人肾部分切除术病例的前瞻性数据库进行了查询，以确定接受单一 cT1 肾肿块手术的患者。将 pT1-2 期肾细胞癌患者与 pT3a 肿瘤患者进行比较，以确定无复发生存率的差异。使用多变量逻辑回归分析研究与 cT1 至 pT3a 分期相关的术前因素。
共有 1096 例患者因 cT1 肾肿块接受机器人肾部分切除术。在最终病理评估中，855 例肿瘤（78.0%）被发现为肾细胞癌，其中 41 例（4.8%）被分期为 pT3a。pT1-2 期和 pT3a 期肿瘤的 24 个月无复发生存估计值分别为 99.2%和 91.8%（p=0.003）。多变量分析显示，高 vs 低 R.E.N.A.L.（半径、外生性/内生性、接近集合系统或窦、前后和相对极线位置）肾切除术评分与肿瘤分期相关（OR 2.97，95%CI 1.20-7.35，p=0.02）。在单独的多变量分析中，肿瘤直径增大（OR 1.66，95%CI 1.32-2.08，p<0.001）和肾门位置（OR 2.83，95%CI 1.43-5.61，p=0.003）也与分期相关。
在短期随访中，肾部分切除术治疗后 cT1 期肾细胞癌患者肿瘤 pT3a 分期有合理的肿瘤学结局。与肿瘤分期相关的因素包括肿瘤复杂性高、肿瘤直径增大和肾门位置。需要进一步研究来确定部分肾切除术与根治性肾切除术治疗小 pT3a 肿瘤的比较疗效。
