T1期肾癌行部分肾切除术可获得与根治性肾切除术相当的肿瘤学疗效，同时能更好地保留肾脏：这是可行之道。

Partial nephrectomy for T1 renal cancer can achieve an equivalent oncological outcome to radical nephrectomy with better renal preservation: the way to go.

作者信息

Lai T Ct, Ma W K, Yiu M K

机构信息

Division of Urology, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.

出版信息

Hong Kong Med J. 2016 Feb;22(1):39-45. doi: 10.12809/hkmj144482. Epub 2015 Oct 23.

DOI:10.12809/hkmj144482

PMID:26492927

Abstract

INTRODUCTION

Patients who undergo partial nephrectomy have been shown to be at decreased risk of renal impairment compared with radical nephrectomy. We examined the oncological outcome of patients in our centre who underwent partial or radical nephrectomy for T1 renal cancer (7 cm or smaller), and compared the likelihood of developing chronic kidney disease.

METHODS

This historical cohort study with internal comparison was conducted in a tertiary hospital in Hong Kong. A cohort of 86 patients with solitary T1 renal cancer and a normal contralateral kidney who underwent radical (38 patients) or partial (48 patients) nephrectomy between January 2005 and December 2010 was included. The overall and cancer-free survival, change in glomerular filtration rate, and new onset of chronic kidney disease were compared between the radical and partial nephrectomy groups.

RESULTS

A total of 32 (84%) radical nephrectomy patients and 43 (90%) partial nephrectomy patients were alive by 31 December 2012. The mean follow-up was 43.5 (standard deviation, 22.4) months. There was no significant difference in overall survival (P=0.29) or cancer-free survival (P=0.29) between the two groups. Both groups enjoyed good oncological outcome with no recurrence in the partial nephrectomy group. Overall, 18 (21%) patients had pre-existing chronic kidney disease. The partial nephrectomy group had a significantly smaller median reduction in glomerular filtration rate (12.6% vs 35.4%; P<0.001), and radical nephrectomy carried a significantly higher risk of developing chronic kidney disease (hazard ratio=5.44; 95% confidence interval, 1.26-23.55; P=0.02).

CONCLUSIONS

Compared with radical nephrectomy, partial nephrectomy can prevent chronic kidney disease and still achieve an excellent oncological outcome for T1 renal tumours, in particular T1a tumours and tumours with a low R.E.N.A.L. score.

摘要

引言

与根治性肾切除术相比，接受部分肾切除术的患者肾功能损害风险降低。我们研究了本中心接受T1期肾癌（7厘米或更小）部分或根治性肾切除术患者的肿瘤学结局，并比较了发生慢性肾脏病的可能性。

方法

这项采用内部对照的历史性队列研究在香港一家三级医院进行。纳入了2005年1月至2010年12月期间接受根治性（38例患者）或部分性（48例患者）肾切除术的86例孤立性T1期肾癌且对侧肾脏正常的患者。比较根治性和部分性肾切除术组之间的总生存率、无癌生存率、肾小球滤过率变化以及慢性肾脏病的新发情况。

结果

到2012年12月31日，共有32例（84%）根治性肾切除术患者和43例（90%）部分性肾切除术患者存活。平均随访时间为43.5（标准差，22.4）个月。两组之间的总生存率（P = 0.29）或无癌生存率（P = 0.29）无显著差异。两组的肿瘤学结局均良好，部分性肾切除术组无复发。总体而言，18例（21%）患者有既往慢性肾脏病。部分性肾切除术组肾小球滤过率的中位数降低显著较小（12.6%对35.4%；P < 0.001），根治性肾切除术发生慢性肾脏病的风险显著更高（风险比 = 5.44；95%置信区间，1.26 - 23.55；P = 0.02）。