基于 SEER 数据库的 T1b-2N0M0 肾肿瘤的部分切除术与根治性切除术比较：倾向评分匹配研究。

Partial versus radical nephrectomy for T1b-2N0M0 renal tumors: A propensity score matching study based on the SEER database.

机构信息

Department of Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.

Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.

出版信息

PLoS One. 2018 Feb 28;13(2):e0193530. doi: 10.1371/journal.pone.0193530. eCollection 2018.

DOI:10.1371/journal.pone.0193530

PMID:29489911

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5830994/

Abstract

PURPOSE

Controversy continues on the tailored therapy for patients with larger renal cell carcinoma (RCC). We investigated whether partial nephrectomy (PN) can improve patient prognosis compared to radical nephrectomy (RN) and the indications for each approach in patients with T1b-2N0M0 RCC.

MATERIALS AND METHODS

A total of 9907 patients were identified from the Surveillance, Epidemiology, and End Results database from 2004 to 2012. Propensity scores were used to balance the selection bias of undergoing PN. Overall (OS) and cancer-specific survival (CSS) of patients undergoing PN and RN were compared. Cases were subdivided to investigate the advantages of each procedure.

RESULTS

Overall, 1418 (14.3%) patients underwent PN. Before matching, PN led to better OS and CSS than RN in both Kaplan-Meier analysis and Cox regression (each p<0.01). For 1412 matched cohorts, PN was no longer associated with significantly better OS (HR: 1.19, 95% CI: 0.98-1.44), but still with a better CSS (HR: 1.66, 95% CI: 1.18-2.27) compared with RN. Further subgroup analysis indicated that patients, who were male, single living, old than 65 years, with T1b stage or clear-cell histologic type, may obtained more oncologic benefit from PN compared to RN.

CONCLUSIONS

When tumor localization and technical feasibility have been taken into account, similar long-term survival was achieved in overall among two nephrectomy modalities, but patients, who were male, old than 65 years, with T1b stage or clear-cell histologic type, got a better survival after receiving PN compared to RN.

摘要

目的

对于较大的肾细胞癌（RCC）患者，有争议的是量身定制的治疗方法。我们研究了部分肾切除术（PN）是否可以改善患者的预后，与根治性肾切除术（RN）相比，以及在 T1b-2N0M0 RCC 患者中每种方法的适应证。

材料和方法

从 2004 年至 2012 年，从监测、流行病学和最终结果数据库中确定了 9907 名患者。使用倾向评分来平衡接受 PN 的选择偏差。比较了接受 PN 和 RN 的患者的总生存期（OS）和癌症特异性生存期（CSS）。将病例细分，以研究每种手术的优势。

结果

总体而言，有 1418 名（14.3%）患者接受了 PN。在匹配之前，PN 在 Kaplan-Meier 分析和 Cox 回归中均优于 RN 的 OS 和 CSS（均<0.01）。对于 1412 个匹配队列，PN 与显著更好的 OS 无关（HR：1.19，95%CI：0.98-1.44），但与 RN 相比，CSS 仍然更好（HR：1.66，95%CI：1.18-2.27）。进一步的亚组分析表明，与 RN 相比，男性、单身、年龄大于 65 岁、T1b 期或透明细胞组织学类型的患者可能从 PN 中获得更多的肿瘤获益。