Yoo Sangjun, You Dalsan, Jeong In Gab, Hong Bumsik, Hong Jun Hyuk, Kim Choung Soo, Ahn Hanjong, Song Cheryn
Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
J Korean Med Sci. 2017 Mar;32(3):495-501. doi: 10.3346/jkms.2017.32.3.495.
This study aimed to determine patients with T1b renal cell carcinoma (RCC) who could benefit from partial nephrectomy (PN) and method to identify them preoperatively using nephrometry score (NS). From a total of 483 radical nephrectomy (RN)-treated patients and 40 PN-treated patients who received treatment for T1b RCC between 1995 and 2010, 120 patients identified through 1:2 propensity-score matching were included for analysis. Probability of chronic kidney disease (CKD) until postoperative 5-years was calculated and regressed with respect to the surgical method and NS. Median follow-up was 106 months. CKD-probability at 5-years was 40.7% and 13.5% after radical and PN, respectively (P = 0.005). While PN was associated with lower risk of CKD regardless of age, comorbidity, preoperative estimated renal function, the effect was observed only among patients with NS ≤ 8 (P < 0.001) but not in patients with NS ≥ 9 (P = 0.746). Percent operated-kidney volume reduction and ischemia time were similar between the patients with NS ≥ 9 and ≤ 8. In the stratified Cox regression accounting for the interaction observed between the surgical method and the NS, PN reduced CKD-risk only in patients with NS ≤ 8 (hazard ratio [HR], 0.054; P = 0.005) but not in ≥ 9 (HR, 0.996; P = 0.994). In T1b RCC with NS ≥ 9, the risk of postoperative CKD was not reduced following PN compared to RN. Considering the potential complications of PN, minimally invasive RN could be considered with priority in this subgroup of patients.
本研究旨在确定可从部分肾切除术（PN）中获益的T1b期肾细胞癌（RCC）患者，以及术前使用肾计量评分（NS）来识别这些患者的方法。在1995年至2010年间接受T1b期RCC治疗的483例接受根治性肾切除术（RN）的患者和40例接受PN治疗的患者中，通过1:2倾向评分匹配确定了120例患者纳入分析。计算术后5年慢性肾脏病（CKD）的概率，并根据手术方法和NS进行回归分析。中位随访时间为106个月。根治性肾切除术后和PN术后5年的CKD概率分别为40.7%和13.5%（P = 0.005）。尽管无论年龄、合并症、术前估计肾功能如何，PN与较低的CKD风险相关，但仅在NS≤8的患者中观察到这种效果（P < 0.001），而在NS≥9的患者中未观察到（P = 0.746）。NS≥9和≤8的患者之间，手术肾体积减少百分比和缺血时间相似。在考虑手术方法和NS之间观察到的相互作用的分层Cox回归分析中，PN仅在NS≤8的患者中降低了CKD风险（风险比[HR]，0.054；P = 0.005），而在NS≥9的患者中未降低（HR，0.996；P = 0.994）。在NS≥9的T1b期RCC中，与RN相比，PN术后CKD风险并未降低。考虑到PN的潜在并发症，对于该亚组患者可优先考虑微创RN。
