Alanee Shaheen, Nutt Max, Moore Aaron, Holland Bradley, Dynda Danuta, Wilber Andrew, El-Zawahry Ahmed
Division of Urology, Southern Illinois University School of Medicine, 301 N Eighth St - St John's Pavilion, PO Box 19665, Springfield, IL, 62794-9665, USA,
Int Urol Nephrol. 2015 Jun;47(6):945-50. doi: 10.1007/s11255-015-0975-3. Epub 2015 Apr 12.
Increasing popularity and improved technical feasibility of partial nephrectomy (PN) has encouraged urologists to treat larger renal masses with nephron-sparing surgery. We used a national database to characterize practice patterns for the surgical management of patients with T2 renal tumors and examined the effect of PN on cancer-specific survival in such patients.
Between 2001 and 2011, 10,259 patients with primary tumor size >7 cm confined to the kidney (T2) were treated surgically for kidney cancer. PN trends were examined using annual percentage change (APC). Multivariate survival models were developed to identify independent determinants of PN use and cancer-specific survival (CSS) following surgical treatment of kidney cancer.
Overall, 543 patients (5.29 %) were treated with PN versus 9716 (94.71 %) who underwent radical nephrectomy (RN). The use of PN increased progressively between 2001 and 2011 (APC +11.1 %, p < 0.05). Male gender, geographic location, year of diagnosis, and disease stage were independent determinants of increased PN use (all p values <0.05). Cancer-specific mortality was not inferior for patients treated with PN versus RN (HR 0.68, 95 % CI 0.50-0.94). Male gender, younger age, white race, tumor size >10 cm, localized disease, and papillary histology were all associated with improved CSS with PN (all p values <0.05).
PN is increasingly utilized to treat T2 renal masses. Our analysis demonstrates that PN for T2 renal masses has no contraindicated effect on CSS.
部分肾切除术（PN）日益普及且技术可行性提高，这促使泌尿外科医生采用保留肾单位手术治疗更大的肾肿瘤。我们使用国家数据库来描述T2期肾肿瘤患者手术治疗的实践模式，并研究PN对此类患者癌症特异性生存的影响。
2001年至2011年间，10259例原发肿瘤大小>7 cm且局限于肾脏（T2）的患者接受了肾癌手术治疗。使用年度百分比变化（APC）来研究PN的趋势。建立多变量生存模型，以确定肾癌手术治疗后PN使用和癌症特异性生存（CSS）的独立决定因素。
总体而言，543例患者（5.29%）接受了PN治疗，而9716例（94.71%）接受了根治性肾切除术（RN）。2001年至2011年间，PN的使用逐渐增加（APC +11.1%，p < 0.05）。男性、地理位置、诊断年份和疾病分期是PN使用增加的独立决定因素（所有p值<0.05）。接受PN治疗的患者与接受RN治疗的患者相比，癌症特异性死亡率并不低（HR 0.68，95% CI 0.50 - 0.94）。男性、年龄较轻、白种人、肿瘤大小>10 cm、局限性疾病和乳头状组织学均与PN治疗后CSS改善相关（所有p值<0.05）。
PN越来越多地用于治疗T2期肾肿瘤。我们的分析表明，PN治疗T2期肾肿瘤对CSS没有禁忌影响。
