Naya Yoshio, Kawauchi Akihiro, Oishi Masakatu, Ueda Takashi, Fujihara Atsuko, Naito Yasuyuki, Nakamura Terukazu, Hongo Fumiya, Kamoi Kazumi, Okihara Koji, Miki Tsuneharu
The Department of Urology, Graduation School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan,
Int J Clin Oncol. 2015 Apr;20(2):358-61. doi: 10.1007/s10147-014-0714-2. Epub 2014 Jun 27.
The aim of this study was to evaluate our institution's experience in performing laparoscopic radical nephrectomy (LRN) and partial nephrectomy (PN) in patients with small renal masses.
142 patients with cT1aN0M0 lesions were identified. 68 of these subjects were treated with LRN and 74 were treated with laparoscopic PN (LPN). The clinicopathological characteristics of the two groups of patients, including diameter-axial-polar (DAP) nephrometry and RENAL nephrometry score (RENAL-NS), operative results, and outcomes, were retrospectively analyzed.
A multivariate logistic regression analysis for the selection of PN as the treatment showed that tumor size, DAP nephrometry, RENAL-NS and imperative condition were all independent factors. The area under the curve receiver operating characteristics (ROC-AUC) of DAP and RENAL-NS for performing LPN were 0.897 and 0.825, respectively.
Although LRN was performed in patients with a high nephrometry score in this study, open partial nephrectomy (OPN) should be considered for patients with a high nephrometry score in T1a renal cell carcinoma (RCC) because of better functional and similar oncological outcomes. Based on ROC analysis, when DAP is 6 or less, LPN should be considered and when DAP is 7 or more, OPN should be considered.
本研究的目的是评估我们机构在为小肾肿块患者实施腹腔镜根治性肾切除术（LRN）和部分肾切除术（PN）方面的经验。
确定了142例cT1aN0M0病变患者。其中68例接受了LRN治疗，74例接受了腹腔镜部分肾切除术（LPN）。对两组患者的临床病理特征，包括直径-轴-极（DAP）肾测量法和RENAL肾测量评分（RENAL-NS）、手术结果及预后进行了回顾性分析。
对选择PN作为治疗方法的多因素逻辑回归分析显示，肿瘤大小、DAP肾测量法、RENAL-NS和必要条件均为独立因素。用于实施LPN的DAP和RENAL-NS的曲线下面积受试者操作特征（ROC-AUC）分别为0.897和0.825。
尽管本研究中对肾测量评分高的患者实施了LRN，但由于功能结局更好且肿瘤学结局相似，对于T1a期肾细胞癌（RCC）肾测量评分高的患者应考虑开放性部分肾切除术（OPN）。基于ROC分析，当DAP为6或以下时，应考虑LPN；当DAP为7或以上时，应考虑OPN。
