Venkatramani Vivek, Koru-Sengul Tulay, Miao Feng, Nahar Bruno, Prakash Nachiketh Soodana, Swain Sanjaya, Punnen Sanoj, Ritch Chad, Gonzalgo Mark, Parekh Dipen
Department of Urology, University of Miami Miller School of Medicine, Miami, FL.
Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL.
Urol Oncol. 2018 Mar;36(3):90.e9-90.e14. doi: 10.1016/j.urolonc.2017.11.008. Epub 2017 Dec 16.
Partial nephrectomy (PN) is the standard management of cT1a renal cell carcinoma (RCC), and there is a basis for expanding its indications to larger tumors (cT1b and cT2). We analyzed a large population-based cancer registry to compare the overall survival (OS) and perioperative outcomes in patients with cT1b and cT2 RCC undergoing PN with those undergoing radical nephrectomy (RN).
Patients with cT1bN0M0 and cT2N0M0 RCC were identified from the National Cancer Database (2004-2013). Patients were classified by the surgery performed and 1:1 propensity matched based on the likelihood of receiving PN. They were then compared for OS, 30-day readmission rates and 30- and 90-day mortality.
A total of 6,072 patients underwent PN. PN was associated with better OS in cT1b tumors on multivariate analyses (OR = 0.8; 95% CI: 0.72-0.89; P<0.001). For cT2 tumors, PN was associated with better OS, however this was not statistically significant (OR = 0.8; 95% CI: 0.62-1.04; P = 0.092). Unplanned readmission at 30 days was significantly more common in patients undergoing PN (4.2%) vs. RN (2.9%) but there was no difference in 30- and 90-day mortality between the 2 groups.
PN was associated with a significantly better OS than RN for cT1b but not cT2 RCC. PN had a higher 30-day readmission rate than RN in these tumors and appropriate patient selection is crucial. These results require further validation, ideally via randomized trials.
部分肾切除术（PN）是cT1a期肾细胞癌（RCC）的标准治疗方法，并且有将其适应证扩大至更大肿瘤（cT1b和cT2）的依据。我们分析了一个基于人群的大型癌症登记数据库，以比较接受PN的cT1b和cT2期RCC患者与接受根治性肾切除术（RN）患者的总生存期（OS）和围手术期结局。
从国家癌症数据库（2004 - 2013年）中识别出cT1bN0M0和cT2N0M0期RCC患者。根据所施行的手术对患者进行分类，并基于接受PN的可能性进行1:1倾向匹配。然后比较两组患者的OS、30天再入院率以及30天和90天死亡率。
共有6072例患者接受了PN。多因素分析显示，PN与cT1b期肿瘤更好的OS相关（OR = 0.8；95%CI：0.72 - 0.89；P<0.001）。对于cT2期肿瘤，PN与更好的OS相关，但无统计学意义（OR = 0.8；95%CI：0.62 - 1.04；P = 0.092）。接受PN的患者30天非计划再入院明显比接受RN的患者更常见（4.2%对2.9%），但两组间30天和90天死亡率无差异。
对于cT1b期RCC，PN的OS显著优于RN，但cT2期RCC并非如此。在这些肿瘤中，PN的30天再入院率高于RN，恰当的患者选择至关重要。这些结果需要进一步验证，理想情况下通过随机试验进行。
