T3aN0M0期肾细胞癌的部分肾切除术：我们要向前迈进吗？
Partial nephrectomy for T3aN0M0 renal cell carcinoma: shall we step forward?
作者信息
Peng Ding, He Zhi-Song, Li Xue-Song, Tang Qi, Zhang Lei, Yang Kai-Wei, Yu Xiao-Teng, Zhang Cui-Jian, Zhou Li-Qun
机构信息
Department of Urology, Institute of Urology, Peking University First Hospital, Beijing, China.
出版信息
Int Braz J Urol. 2017 Sep-Oct;43(5):849-856. doi: 10.1590/S1677-5538.IBJU.2016.0598.
OBJECTIVES
To evaluate the prognosis of non-metastatic T3a renal cell carcinoma (RCC) with partial nephrectomy (PN).
PATIENTS AND METHODS
We retrospectively evaluated 125 patients with non-metastatic T3a RCC. Patients undergoing PN and radical nephrectomy (RN) were strictly matched by clinic-pathologic characteristics. Log-rank test and Cox regression model were used for univariate and multivariate analysis.
RESULTS
18 pair patients were matched and the median follow-up was 35.5 (10-86) months. PN patients had a higher postoperative eGFR than RN patients (P=0.034). Cancer-specific survival (CSS) and recurrence-free survival (RFS) did not differ between two groups (P=0.305 and P=0.524). On multivariate analysis, CSS decreased with positive surgical margin and anemia (both P<0.01) and RFS decreased with Furhman grade, positive surgical margin, and anemia (all P<0.01).
CONCLUSIONS
For patients with non-metastatic pT3a RCC, PN may be a possible option for similar oncology outcomes and better renal function.
目的
评估接受部分肾切除术（PN）的非转移性T3a期肾细胞癌（RCC）的预后。
患者与方法
我们回顾性评估了125例非转移性T3a期RCC患者。接受PN和根治性肾切除术（RN）的患者根据临床病理特征进行严格匹配。采用对数秩检验和Cox回归模型进行单因素和多因素分析。
结果
匹配了18对患者，中位随访时间为35.5（10 - 86）个月。PN患者术后的估算肾小球滤过率（eGFR）高于RN患者（P = 0.034）。两组之间的癌症特异性生存率（CSS）和无复发生存率（RFS）无差异（P = 0.305和P = 0.524）。多因素分析显示，CSS随手术切缘阳性和贫血而降低（均P < 0.01），RFS随富尔曼分级、手术切缘阳性和贫血而降低（均P < 0.01）。
结论
对于非转移性pT3a期RCC患者，PN可能是一种在肿瘤学结局相似且肾功能更好的情况下的可行选择。
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