Srivastava Arnav, Patel Hiten D, Joice Gregory A, Semerjian Alice, Gorin Michael A, Johnson Michael H, Allaf Mohamad E, Pierorazio Phillip M
James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD.
James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD.
Urol Oncol. 2018 Jan;36(1):12.e7-12.e13. doi: 10.1016/j.urolonc.2017.09.005. Epub 2017 Sep 29.
The use of partial nephrectomy (PN) to treat renal cell carcinoma has grown to include larger, more complex tumors. Such tumors are more likely to be up-staged to pT3a and generate controversy regarding the oncologic safety of PN. We aimed to estimate the proportion of patients up-staged to T3a disease after PN, stratified by clinical stage, and characterize their survival.
From 1998 to 2013, pT1-pT3aN0M0 kidney cancer patients undergoing PN or radical nephrectomy (RN) were identified from the Surveillance Epidemiology and End Results registries. Cox proportional hazards models compared cancer-specific (CSS) and overall survival (OS) for PN patients with pT1a, pT1b, and pT2 disease to stratified, up-staged pT3a patients undergoing PN. Also, we compared PN patients with up-staged pT3a disease to RN patients with pT3a disease.
From the 28,854 patients undergoing PN, the estimated proportion up-staged to pT3a was 4.2%, 9.5%, and 19.5% for cT1a, cT1b, and cT2, respectively. OS was worse for tumors up-staged from cT1a to pT3a, but not for cT1b or cT2 tumors. Up-staged pT3a tumors across all stage strata demonstrated worse CSS, with worse survival for larger tumors. Analysis revealed no difference in OS or CSS for up-staged pT3a PN patients compared to pT3a RN patients.
A greater proportion of patients experience T3a up-staging after PN with increasing initial T stage. Up-staged pT3a patients have worse CSS across all clinical tumor stages after PN. However, our results do not demonstrate that patients up-staged after PN have compromised oncologic outcomes compared to all-comers with pT3a disease receiving RN.
部分肾切除术（PN）用于治疗肾细胞癌的应用范围已扩大到包括更大、更复杂的肿瘤。这类肿瘤更有可能被上调至pT3a期，并引发了关于PN肿瘤学安全性的争议。我们旨在估计PN术后上调至T3a期疾病的患者比例，按临床分期分层，并描述其生存情况。
从1998年至2013年，从监测、流行病学和最终结果登记处识别出接受PN或根治性肾切除术（RN）的pT1 - pT3aN0M0肾癌患者。Cox比例风险模型比较了pT1a、pT1b和pT2期PN患者与分层上调至pT3a期的PN患者的癌症特异性生存（CSS）和总生存（OS）。此外，我们还比较了上调至pT3a期的PN患者与pT3a期RN患者。
在28854例接受PN的患者中，cT1a、cT1b和cT2期上调至pT3a的估计比例分别为4.2%、9.5%和19.5%。从cT1a上调至pT3a的肿瘤患者OS较差，但cT1b或cT2肿瘤患者并非如此。所有分期分层中上调至pT3a的肿瘤患者CSS较差，肿瘤越大生存越差。分析显示，上调至pT3a的PN患者与pT3a期RN患者相比，OS或CSS无差异。
随着初始T分期增加，PN术后上调至T3a期的患者比例更高。PN术后上调至pT3a期的患者在所有临床肿瘤分期中CSS均较差。然而，我们的结果并未表明，与接受RN的所有pT3a期患者相比，PN术后上调分期的患者肿瘤学结局受损。
