Department of Urology, Fundacion Instituto Valenciano Oncologia, Valencia, Spain.
Urology Clinic, Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy.
World J Urol. 2020 Jan;38(1):151-158. doi: 10.1007/s00345-019-02665-2. Epub 2019 Apr 1.
To compare the outcomes of PN to those of RN in very elderly patients treated for clinically localized renal tumor.
A purpose-built multi-institutional international database (RESURGE project) was used for this retrospective analysis. Patients over 75 years old and surgically treated for a suspicious of localized renal with either PN or RN were included in this database. Surgical, renal function and oncological outcomes were analyzed. Propensity scores for the predicted probability to receive PN in each patient were estimated by logistic regression models. Cox proportional hazard models were estimated to determine the relative change in hazard associated with PN vs RN on overall mortality (OM), cancer-specific mortality (CSM) and other-cause mortality (OCM).
A total of 613 patients who underwent RN were successfully matched with 613 controls who underwent PN. Higher overall complication rate was recorded in the PN group (33% vs 25%; p = 0.01). Median follow-up for the entire cohort was 35 months (interquartile range [IQR] 13-63 months). There was a significant difference between RN and PN in median decline of eGFR (39% vs 17%; p < 0.01). PN was not correlated with OM (HR = 0.71; p = 0.56), OCM (HR = 0.74; p = 0.5), and showed a protective trend for CSM (HR = 0.19; p = 0.05). PN was found to be a protective factor for surgical CKD (HR = 0.28; p < 0.01) and worsening of eGFR in patients with baseline CKD. Retrospective design represents a limitation of this analysis.
Adoption of PN in very elderly patients with localized renal tumor does not compromise oncological outcomes, and it allows better functional preservation at mid-term (3-year) follow-up, relative to RN. Whether this functional benefit translates into a survival benefit remains to be determined.
比较经皮肾镜取石术（PN）与根治性肾切除术（RN）治疗局限性肾肿瘤超高龄患者的结局。
本回顾性分析使用了一个专门构建的多机构国际数据库（RESURGE 项目）。该数据库纳入了年龄超过 75 岁且接受手术治疗疑似局限性肾肿瘤的患者，包括接受 PN 或 RN 治疗的患者。分析了手术、肾功能和肿瘤学结局。通过逻辑回归模型估计每位患者接受 PN 的预测概率的倾向评分。使用 Cox 比例风险模型确定与 RN 相比，PN 对总体死亡率（OM）、癌症特异性死亡率（CSM）和其他原因死亡率（OCM）的风险比的相对变化。
共纳入 613 例接受 RN 的患者，并成功匹配了 613 例接受 PN 的对照组患者。PN 组的总体并发症发生率更高（33% vs 25%；p=0.01）。整个队列的中位随访时间为 35 个月（四分位距 [IQR] 13-63 个月）。RN 和 PN 之间的 eGFR 中位数下降存在显著差异（39% vs 17%；p<0.01）。PN 与 OM（HR=0.71；p=0.56）、OCM（HR=0.74；p=0.5）无相关性，并且对 CSM 显示出保护趋势（HR=0.19；p=0.05）。PN 是手术性慢性肾脏疾病（CKD）（HR=0.28；p<0.01）和基线 CKD 患者 eGFR 恶化的保护因素。回顾性设计是本分析的一个局限性。
在局限性肾肿瘤超高龄患者中采用 PN 不会影响肿瘤学结局，并且与 RN 相比，在中期（3 年）随访时能够更好地保留肾功能。这种功能获益是否转化为生存获益仍有待确定。
