Cai Yi, Li Han-Zhong, Zhang Yu-Shi
Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. 1 Shuaifuyuan Road, Beijing, China, 100730.
Urol J. 2018 Mar 18;15(2):16-20. doi: 10.22037/uj.v0i0.3913.
To compare the long-term clinical and oncologic outcomes in patients treated with laparoscopic partial nephrectomy (LPN) and laparoscopic radial nephrectomy (LRN) for clinical T1b renal cell carcinoma.
We retrospectively reviewed the records of all patients who underwent LPN or LRN for a single clinical T1b tumor between January 2005 and January 2012, an actual follow-up of 2-year or greater was available in 39 and 160 after LPN and LRN, respectively. Survival was calculated using the Kaplan-Meier method. Multivariable Cox regression analysis was done to assess predictors of survival.
The two cohorts of patients were similar in age, sex, body-mass index and preoperative eGFR. There were no differences in tumors size (4.97 vs 5.29cm, P = .08), and pathological stage distribution between the two cohorts. The median follow-up after LPN and LRN were 67 (range: 18-118) and 70 (19-120) months, respectively. For LPN versus LRN, 5-years overall and cancer specific survival rates were 93.33% vs 85.69% and 96.00% vs 91.35%, respectively. For LPN versus LRN, 10-years overall and cancer specific survival rates were 85.56% vs73.41% and 88.00% vs 82.85%, respectively. On multivariate analysis, patients' age, ASA score and pathological stage were the major factors affecting overall survival, and patients' age and pathological stage were associated with cancer specific survival. The percent decrease in glomerular filtration rate was significantly lower in the LRN group at early and last followup.
LPN is an effective treatment option in appropriately selected patients with cT1b RCC. It provides 5-year, 10-year overall survival and cancer specific survival comparable to those of LRN as well as better preservation of renal function than LRN. Overall survival and cancer specific survival are associated with nonmodifiable factors but not by the choice of operative technique.
比较接受腹腔镜部分肾切除术（LPN）和腹腔镜根治性肾切除术（LRN）治疗的临床T1b期肾细胞癌患者的长期临床和肿瘤学结局。
我们回顾性分析了2005年1月至2012年1月期间因单一临床T1b期肿瘤接受LPN或LRN治疗的所有患者的记录，LPN和LRN后分别有39例和160例患者有2年或更长时间的实际随访。采用Kaplan-Meier法计算生存率。进行多变量Cox回归分析以评估生存预测因素。
两组患者在年龄、性别、体重指数和术前估算肾小球滤过率方面相似。两组患者的肿瘤大小（4.97对5.29cm，P = 0.08）和病理分期分布无差异。LPN和LRN后的中位随访时间分别为67（范围：18 - 118）和70（19 - 120）个月。LPN与LRN相比，5年总生存率和癌症特异性生存率分别为93.33%对85.69%和96.00%对91.35%。LPN与LRN相比，10年总生存率和癌症特异性生存率分别为85.56%对73.41%和88.00%对82.85%。多变量分析显示，患者年龄、美国麻醉医师协会（ASA）评分和病理分期是影响总生存的主要因素，患者年龄和病理分期与癌症特异性生存相关。在早期和末次随访时，LRN组肾小球滤过率的下降百分比显著更低。
对于适当选择的cT1b期肾细胞癌患者，LPN是一种有效的治疗选择。它提供的5年、10年总生存率和癌症特异性生存率与LRN相当，并且比LRN能更好地保留肾功能。总生存和癌症特异性生存与不可改变的因素相关，而非手术技术的选择。
