Cho Chan Woo, Lee Kyo Won, Park Hyojun, Kim Hyung Joon, Park Jae Berm, Choi Yoon-La, Yu Jeong Il, Lee Su Jin, Choi Dong Il, Kim Sung Joo
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Asia Pac J Clin Oncol. 2018 Oct;14(5):e465-e471. doi: 10.1111/ajco.12769. Epub 2017 Oct 18.
The purpose of this study was to evaluate the efficacy of en bloc nephrectomy for perirenal retroperitoneal sarcoma (RPS) with respect to postoperative kidney function and oncological benefits.
We performed a comparative study of 114 patients undergoing surgery for primary RPS, classifying cases as nephrectomy (NPX, n = 65) versus no nephrectomy (no-NPX, n = 49). The Δ and % change between preoperative and postoperative estimated glomerulus filtration rate (eGFR) were analyzed to compare renal function changes after surgery. Kaplan-Meier analysis was performed to verify the incidence of local relapse between the two groups.
During a median follow-up of 29 months, median postoperative GFR of 65 patients in the NPX group decreased to 73.5% of preoperative eGFR. Although 38 patients (58%) in the NPX group experienced a progression in chronic kidney disease stage after nephrectomy, no patients progressed to end-stage renal disease (ESRD). In French Federation of Cancer Centers Sarcoma grade 2, the NPX group had statistically significant local control benefits, compared with the no-NPX group (P = 0.048).
Residual renal function after en bloc nephrectomy was stabilized without progression to ESRD. Moreover, en bloc nephrectomy for perirenal RPS might secure a complete resection margin for local tumor control.
本研究旨在评估整块肾切除术治疗肾周腹膜后肉瘤（RPS）对术后肾功能及肿瘤学获益的疗效。
我们对114例行原发性RPS手术的患者进行了一项对比研究，将病例分为肾切除术组（NPX，n = 65）和非肾切除术组（非NPX，n = 49）。分析术前和术后估计肾小球滤过率（eGFR）的变化量（Δ）及变化百分比（%），以比较术后肾功能的变化。采用Kaplan-Meier分析来验证两组局部复发的发生率。
在中位随访29个月期间，NPX组65例患者术后中位GFR降至术前eGFR的73.5%。尽管NPX组38例患者（58%）在肾切除术后慢性肾脏病分期出现进展，但无患者进展至终末期肾病（ESRD）。在法国癌症中心肉瘤分级2级中，与非NPX组相比，NPX组具有统计学显著的局部控制获益（P = 0.048）。
整块肾切除术后残余肾功能稳定，未进展至ESRD。此外，肾周RPS的整块肾切除术可能为局部肿瘤控制确保完整的切缘。
