Nason Gregory J, Walsh Leon G, Redmond Ciaran E, Kelly Niall P, McGuire Barry B, Sharma Vidit, Kelly Michael E, Galvin David J, Mulvin David W, Lennon Gerald M, Quinlan David M, Flood Hugh D, Giri Subhasis K
University Hospital Limerick, St. Nessan's Road, Limerick Ireland;
St. Vincent University Hospital, Dublin, Ireland;
Can Urol Assoc J. 2015 Sep-Oct;9(9-10):E583-8. doi: 10.5489/cuaj.2842. Epub 2015 Sep 9.
We compare the survival outcomes of patients with clear cell renal cell carcinoma (RCC) treated with adrenal sparing radical nephrectomy (ASRN) and non-adrenal sparing radical nephrectomy (NASRN).
We conducted an observational study based on a composite patient population from two university teaching hospitals who underwent RN for RCC between January 2000 and December 2012. Only patients with pathologically confirmed RCC were included. We excluded patients undergoing cytoreductive nephrectomy, with loco-regional lymph node involvement. In total, 579 patients (ASRN = 380 and NASRN = 199) met our study criteria. Patients were categorized by risk groups (all stage, early stage and locally advanced RCC). Overall survival (OS) and cancer-specific survival (CSS) were analyzed for risk groups. Survival analysis was performed using Kaplan-Meier curves and Cox proportional hazards regression.
The median follow-up was 41 months (range: 12-157). There were significant benefits in OS (ASRN 79.5% vs. NASRN 63.3%; p = 0.001) and CSS (84.3% vs. 74.9%; p = 0.001), with any differences favouring ASRN in all stage. On multivariate analysis, there was a trend towards worse OS (hazard ratio [HR] 1.759, 95% confidence interval [CI] 0.943-2.309, p = 0.089) and CSS (HR 1.797, 95% CI 0.967-3.337, p = 0.064) in patients with NASRN (although not statistically significant). Of these patients, only 11 (1.9%) had adrenal involvement.
The inherent limitations in our study include the impracticality of conducting a prospective randomized trial in this scenario. Our observational study with a 13-year follow-up suggests ASRN leads to better survival than NASRN. ASRN should be considered the gold standard in treating patients with RCC, unless it is contraindicated.
我们比较了接受保留肾上腺根治性肾切除术（ASRN）和不保留肾上腺根治性肾切除术（NASRN）治疗的透明细胞肾细胞癌（RCC）患者的生存结局。
我们基于来自两家大学教学医院的综合患者群体进行了一项观察性研究，这些患者在2000年1月至2012年12月期间因RCC接受了肾切除术。仅纳入病理确诊为RCC的患者。我们排除了接受减瘤性肾切除术、有局部区域淋巴结受累的患者。共有579例患者（ASRN = 380例，NASRN = 199例）符合我们的研究标准。患者按风险组（所有分期、早期和局部晚期RCC）进行分类。对风险组分析总生存期（OS）和癌症特异性生存期（CSS）。使用Kaplan-Meier曲线和Cox比例风险回归进行生存分析。
中位随访时间为41个月（范围：12 - 157个月）。在OS（ASRN为79.5% vs. NASRN为63.3%；p = 0.001）和CSS（84.3% vs. 74.9%；p = 0.001）方面存在显著益处，在所有分期中任何差异均有利于ASRN。多因素分析显示，NASRN患者的OS（风险比[HR] 1.759，95%置信区间[CI] 0.943 - 2.309，p = 0.089）和CSS（HR 1.797，95% CI 0.967 - 3.337，p = 0.064）有变差的趋势（尽管无统计学意义）。在这些患者中，仅11例（1.9%）有肾上腺受累。
我们研究的固有局限性包括在这种情况下进行前瞻性随机试验不切实际。我们长达13年随访的观察性研究表明，ASRN比NASRN能带来更好的生存。除非有禁忌证，ASRN应被视为治疗RCC患者的金标准。
