Department of Urology, Inje University Haeundae Paik Hospital, Busan, Korea.
Department of Biostatistics, Yonsei University, Seoul, Korea.
J Korean Med Sci. 2018 Oct 1;33(43):e277. doi: 10.3346/jkms.2018.33.e277. eCollection 2018 Oct 22.
To examine survival rates and renal function after partial nephrectomy (PN) and radical nephrectomy (RN) in patients with chronic kidney disease (CKD).
We studied 4,332 patients who underwent PN or RN for pathological T1a-T2N0M0 renal cell carcinoma from 1988 to 2014. Patients were divided into two subgroups of CKD stage I-II and stage III. Kidney function, and survival outcomes were compared between groups.
We included 1,756 patients with CKD I-II and 276 patients with CKD III in the final pair-matched analysis. Kidney function was significantly better preserved in the PN than in the RN group among all patients. However, the beneficial effect of PN on kidney function gradually disappeared over time in CKD III patients. The 5-year overall survival (OS) rates after PN and RN differed in patients with CKD I-II disease (99.4% vs. 96.5%, respectively, = 0.015). The 5-year OS rates after surgery were not affected by mode of nephrectomy in CKD III patients (97.8% vs. 93.5%, = 0.103). The 5-year cancer-specific survival rates did not differ between treatment groups in all CKD stage. Cox hazard analysis showed that the operative method was a significant factor for OS in CKD I-II patients (hazard ratio [HR], 0.320; confidence interval [CI], 0.122-0.840; = 0.021). However, PN was not beneficial in terms of OS in CKD III patients (HR, 0.395; CI, 0.086-1.172; = 0.117).
PN is associated with a higher OS rate and better kidney function in patients with preoperative CKD stage I and II, but not in those with CKD stage III.
探讨慢性肾脏病（CKD）患者行部分肾切除术（PN）和根治性肾切除术（RN）后的生存率和肾功能。
我们研究了 1988 年至 2014 年间因病理 T1a-T2N0M0 肾细胞癌行 PN 或 RN 的 4332 例患者。患者分为 CKD Ⅰ-Ⅱ期和Ⅲ期两个亚组。比较组间肾功能和生存结局。
最终配对匹配分析纳入了 1756 例 CKD Ⅰ-Ⅱ期患者和 276 例 CKD Ⅲ期患者。所有患者中，PN 组的肾功能保存明显优于 RN 组。然而，在 CKD Ⅲ期患者中，PN 对肾功能的有益影响随时间的推移逐渐消失。CKD Ⅰ-Ⅱ期患者中，PN 和 RN 后的 5 年总生存率（OS）分别为 99.4%和 96.5%（=0.015）。CKD Ⅲ期患者手术方式对 OS 无影响（97.8% vs. 93.5%，=0.103）。所有 CKD 分期患者的治疗组间 5 年癌症特异性生存率无差异。Cox 风险分析显示，在 CKD Ⅰ-Ⅱ期患者中，手术方式是 OS 的显著因素（风险比 [HR]，0.320；置信区间 [CI]，0.122-0.840；=0.021）。然而，PN 对 CKD Ⅲ期患者的 OS 无益（HR，0.395；CI，0.086-1.172；=0.117）。
在术前 CKD Ⅰ和Ⅱ期患者中，PN 与较高的 OS 率和更好的肾功能相关，但在 CKD Ⅲ期患者中则不然。
