肿瘤大小超过7厘米是否会影响肾癌治疗中部分肾切除术的结果？
[Does a tumor size higher than 7cm impact partial nephrectomy outcomes for the treatment of renal cancer?].
作者信息
Benoit T, Nouhaud F X, Roumiguié M, Mérigot De Treigny O, Thoulouzan M, Doumerc N, Bellec L, Gamé X, Rischmann P, Soulié M, Huyghe E, Beauval J B
机构信息
Service d'urologie, andrologie et transplantation rénale, centre hospitalier universitaire de Toulouse Rangueil, 1, avenue du Professeur-Jean-Poulhes, 31400 Toulouse, France.
Service d'urologie, andrologie et transplantation rénale, centre hospitalier universitaire de Toulouse Rangueil, 1, avenue du Professeur-Jean-Poulhes, 31400 Toulouse, France.
出版信息
Prog Urol. 2015 Mar;25(3):138-44. doi: 10.1016/j.purol.2014.11.007. Epub 2014 Dec 31.
OBJECTIVE
To assess the impact of a tumor size higher than 7cm on partial nephrectomy (PN) outcomes compared to a tumor size ranging between 4 and 7cm and to compare this impact to one of the RENAL score.
PATIENTS AND METHODS
Data from patients who underwent PN between 2006 and 2013 were retrospectively analysed. Patients with cT1b tumors and cT2 were included. Functional and oncological outcomes were compared. Analysis of the achievement of Trifecta (defined as a combination of warm ischemia time<25min, negative surgical margins and no perioperative complications) was performed according to the tumor size and the RENAL score.
RESULTS
Among 334 PN, 57 patients were included, (41 cT1b and 16 cT2), with a median follow-up of 23.5 months (6-88). There was no difference between the groups regarding intraoperative parameters except for the conversion rate, which was higher in the cT2 group (30% vs. 4.3%; P=0.02). The cT2 group also presented higher renal function impairment at postoperative day 4 (P=0.04) which did not persist at 6 months. There was no significant difference in oncologic outcomes between the 2 groups. The rate of achievement of the Trifecta did not differ between cT1b and cT2 groups. Conversely, Trifecta rate was higher in case of low complexity renal masses (RENAL score 4-6) compared to complex renal tumors (RENAL score 7-9 and 10-12).
CONCLUSION
Our results showed that a tumor size higher than 7cm had no impact on PN outcomes in selected tumors according to complexity scores such as the RENAL score. Furthermore, a lower RENAL score appeared to be significantly associated with the Trifecta achievement.
LEVEL OF EVIDENCE
目的
评估肿瘤大小大于7cm与肿瘤大小在4至7cm之间相比，对部分肾切除术（PN）结果的影响，并将此影响与RENAL评分的影响进行比较。
患者与方法
回顾性分析2006年至2013年间接受PN的患者数据。纳入cT1b肿瘤和cT2肿瘤患者。比较功能和肿瘤学结果。根据肿瘤大小和RENAL评分对三联成功（定义为热缺血时间<25分钟、手术切缘阴性且无围手术期并发症的组合）的达成情况进行分析。
结果
在334例PN中，纳入57例患者（41例cT1b和16例cT2），中位随访时间为23.5个月（6 - 88个月）。除了中转率外，两组术中参数无差异，cT2组中转率更高（30%对4.3%；P = 0.02）。cT2组在术后第4天肾功能损害也更严重（P = 0.04），但6个月时未持续存在。两组肿瘤学结果无显著差异。cT1b组和cT2组三联成功的发生率无差异。相反，与复杂肾肿瘤（RENAL评分7 - 9和10 - 12）相比，低复杂性肾肿块（RENAL评分4 - 6）的三联成功率更高。
结论
我们的结果表明，根据RENAL评分等复杂性评分，肿瘤大小大于7cm对所选肿瘤的PN结果没有影响。此外，较低的RENAL评分似乎与三联成功的达成显著相关。
证据级别
5级
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