de Saint Aubert N, Audenet F, Mccaig F, Delavaud C, Verkarre V, Le Guilchet T, Dariane C, Pettenati C, Slaoui H, Mejean A, Timsit M O
Hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
Hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
Prog Urol. 2018 May;28(6):336-343. doi: 10.1016/j.purol.2018.03.009. Epub 2018 Apr 23.
Partial nephrectomy (PN) is the gold standard treatment for renal cell carcinomas under 4cm. No robust data exists to recommend PN for tumours>7cm (cT2). The objective of this work is to evaluate the results of PN for cT2 tumours.
All patients who underwent PN or radical nephrectomy (RN) for cT2 tumours between 2000 and 2013 at our institution have been included. Patient demographics, postoperative data including renal function, morbidity, mortality and oncologic outcomes were reviewed retrospectively and compared using χ test, Mann-Whitney test, Kaplan-Meier method and log rank test.
We included 130 patients, 49 (38%) in the PN group and 81 (62%) in the RN group, with a median follow-up of 42 months [19-69]. Variation of postoperative renal function at day 5 and last recorded value was significantly different between the groups (P=0.03 and P<0.001). The PN group had a significantly higher complication rate as compared with RN group (37% versus 14%, P=0.002). There were no significant differences between the two groups for overall, recurrence free and specific survival (P=0.55, P=0.55, P=0.24, respectively). In univariate analysis, the type of surgery (PN versus RN) was not associated with a significant difference of oncologic outcome (margins, survival).
PN can be offered for cT2 tumours with oncological outcomes similar to RN. Despite an increased morbidity, it remains acceptable with the demonstrated advantage of preservation of renal function.
部分肾切除术（PN）是治疗直径小于4cm肾细胞癌的金标准。目前尚无有力数据支持对直径>7cm（cT2）的肿瘤行PN治疗。本研究旨在评估PN治疗cT2肿瘤的效果。
纳入2000年至2013年间在我院因cT2肿瘤接受PN或根治性肾切除术（RN）的所有患者。回顾性分析患者的人口统计学资料、术后数据，包括肾功能、发病率、死亡率和肿瘤学结局，并采用χ检验、Mann-Whitney检验、Kaplan-Meier法和对数秩检验进行比较。
共纳入130例患者，PN组49例（38%），RN组81例（62%），中位随访时间为42个月[19 - 69个月]。两组术后第5天和最后记录值的肾功能变化有显著差异（P = 0.03和P < 0.001）。PN组的并发症发生率显著高于RN组（37%对14%，P = 0.002）。两组在总生存率、无复发生存率和特异性生存率方面无显著差异（分别为P = 0.55、P = 0.55、P = 0.24）。单因素分析显示，手术方式（PN与RN）与肿瘤学结局（切缘、生存率）的显著差异无关。
对于cT2肿瘤，PN可获得与RN相似的肿瘤学结局。尽管发病率增加，但鉴于其在保留肾功能方面的优势，仍是可以接受的。
4级。
