Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas.
Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas.
J Urol. 2017 Nov;198(5):1021-1026. doi: 10.1016/j.juro.2017.04.080. Epub 2017 Apr 23.
The overall recurrence rate of T1 renal cell carcinoma is low. We evaluated abdominal imaging after partial nephrectomy based on current guidelines for T1 renal cell carcinoma surveillance.
We retrospectively reviewed the records of patients with T1 renal cell carcinoma who underwent partial nephrectomy between 2006 and 2012 followed by abdominal imaging at our institution. Primary and secondary outcomes were the incidence and timing, respectively, of imaging diagnosed abdominal recurrences. A literature review was performed to summarize prior reports of recurrence incidence and timing after partial nephrectomy for T1 disease.
A total of 160 patients with stage T1a and 37 with T1b underwent partial nephrectomy. Seven patients had an abdominal recurrence, including 3 with local and distant recurrences, and 4 with a metachronous contralateral kidney recurrence. The incidence of abdominal recurrence detected by imaging was higher in the T1b than in the T1a group (10.8% vs 1.9%, p = 0.024). Although it was not significant, median time to recurrence was earlier in T1b vs T1a cases (13 vs 37 months, p = 0.480). In each group recurrences developed after 3 years of suggested guideline surveillance. In the literature combined with the current study the time to median recurrence for T1b vs T1a was 24 vs 29 months (p = 0.226).
Recurrences detected by abdominal imaging developed earlier and more frequently in T1b than in T1a cases. Future recommendations for surveillance strategies after partial nephrectomy should distinguish T1a from T1b with less intense frequency of imaging for T1a. A longer period of surveillance should be considered since recurrences can develop beyond 3 years.
T1 肾细胞癌的总体复发率较低。我们根据 T1 肾细胞癌监测的现行指南，评估了肾部分切除术后的腹部影像学检查。
我们回顾性分析了 2006 年至 2012 年间在我院行肾部分切除术且随后进行腹部影像学检查的 T1 肾细胞癌患者的病历。主要和次要结局分别为影像学诊断的腹部复发的发生率和时间。我们进行了文献复习，以总结 T1 期肾部分切除术后局部复发和远处复发的发生率和时间。
共有 160 例 T1a 期和 37 例 T1b 期患者行肾部分切除术。7 例患者出现腹部复发，其中 3 例为局部和远处复发，4 例为对侧肾脏的异时性复发。T1b 组的腹部复发检出率高于 T1a 组（10.8%比 1.9%，p = 0.024）。虽然无统计学意义，但 T1b 组的中位复发时间早于 T1a 组（13 比 37 个月，p = 0.480）。在每组中，复发均发生在建议的指南监测 3 年后。结合本研究，文献中 T1b 与 T1a 的中位复发时间分别为 24 与 29 个月（p = 0.226）。
T1b 比 T1a 患者的腹部影像学检查更能早期和频繁地发现复发。肾部分切除术后的监测策略建议根据肿瘤分期，对 T1a 与 T1b 进行区分，减少 T1a 患者的影像学检查频率。由于复发可能在 3 年后发生，因此应考虑更长的监测时间。
