Department of Urology, Sheba Medical Center, Tel Hashomer, affiliated with Tel Aviv University, Tel Aviv, Israel.
Department of Urology, Bnai Zion Medical Center, and Technion-Israel Institute of Technology, Haifa, Israel.
Clin Genitourin Cancer. 2018 Jun;16(3):e613-e617. doi: 10.1016/j.clgc.2017.10.016. Epub 2017 Nov 7.
Partial nephrectomy (PN) for clinical stage T3 tumors is controversial. Radical nephrectomy (RN) has been associated with a greater rate of chronic kidney disease, an increased risk of cardiovascular disease, and increased mortality compared with PN. We present our long-term 2-center experience with PN for stage pT3a tumors and compare the oncologic outcomes with those of similar patients treated with RN.
We reviewed the data from all patients who had undergone nephrectomy for renal cell carcinoma from 1987 to 2015 in 2 medical centers. The study included 134 patients with pathologic stage T3a tumors, of whom 48 and 86 underwent PN and RN, respectively. We compared the 2 groups (PN and RN) using univariate and multivariate analyses.
The tumors of all patients with pathologic stage T3a who had undergone PN had been pathologically upstaged from clinical stage T1 or T2. Univariate and multivariate analyses revealed tumor size was significantly different statistically between the study groups (median, 7.0 cm in RN group vs. 4.0 cm in PN group; P < .001). Surgery type was not a predictor of local recurrence (P = .978), metastatic progression (P = .972), death from renal cancer (P = .626), or death from all causes (P = .974) at the 5-year follow-up point.
The results of the present study have shown similar oncologic outcomes between 48 patients with stage pT3a renal cancer who underwent PN and 86 patients who underwent RN. Although PN was not performed on clinical T3a tumors, our findings suggest that PN can also be considered for these tumors and, thus, avoid the long-term complications of RN. However, strict follow-up protocols are mandatory.
对于临床 T3 期肿瘤，部分肾切除术（PN）存在争议。与 PN 相比，根治性肾切除术（RN）与更高的慢性肾脏病发生率、心血管疾病风险增加以及死亡率增加相关。我们报告了在 2 个中心对 T3a 期肿瘤进行 PN 的长期经验，并将其与接受 RN 治疗的类似患者的肿瘤学结果进行了比较。
我们回顾了 1987 年至 2015 年在 2 个医疗中心接受肾细胞癌切除术的所有患者的数据。研究包括 134 例病理分期为 T3a 期的患者，其中 48 例和 86 例分别接受了 PN 和 RN。我们使用单变量和多变量分析比较了这 2 组（PN 和 RN）。
所有接受 PN 的病理 T3a 期肿瘤患者的肿瘤均已从临床 T1 或 T2 期病理升级。单变量和多变量分析显示，研究组之间肿瘤大小存在显著统计学差异（RN 组的中位数为 7.0cm，PN 组为 4.0cm；P<0.001）。手术类型不是局部复发（P=0.978）、转移性进展（P=0.972）、肾癌死亡（P=0.626）或所有原因死亡（P=0.974）的预测因素。
本研究结果表明，48 例接受 PN 的 pT3a 期肾癌患者和 86 例接受 RN 的患者的肿瘤学结果相似。尽管没有对临床 T3a 期肿瘤进行 PN，但我们的研究结果表明，PN 也可用于这些肿瘤，从而避免 RN 的长期并发症。但是，必须制定严格的随访方案。
