Department of Urology, The Affiliated Hospital of Hang Zhou Normal University, Hangzhou, 310015, China.
School of Medicine, Hang Zhou Normal University, Hangzhou, 310016, China.
BMC Urol. 2019 Jun 7;19(1):48. doi: 10.1186/s12894-019-0480-6.
The efficacy of partial nephrectomy (PN) for T1b renal cell carcinoma (RCC) is controversial. The oncological outcomes, the change in postoperative renal function and the perioperative complications are unclear.
We searched PUBMED, EMBASE and the Cochrane Central Register for studies from March 1998 to March 2018 for studies comparing PN to radical nephrectomy (RN) for the treatment of T1b RCC. After data extraction and quality assessment, we used RevMan 5.2 to pool the data. Then, we used Stata 12.0 to perform sensitivity analyses and meta-regression. We used the GRADE profiler to evaluate the evidence according to the GRADE approach.
A total of 16 studies involving 33,117 patients were included in our meta-analysis. No significant difference was found in the 5-year overall survival (OS), 10-year OS, 5-year recurrence-free survival (RFS) and 10-year RFS. The 5-year cancer-special survival (CSS) and 10-year CSS were better in RN compared to PN, respectively, at RR = 1.02, P < 0.05 and RR = 1.04, P < 0.05. PN was better than RN in the preservation of renal function (WMD = -9.15, 95% CI: - 10.30 to - 7.99, P < 0.05). The confidence level grading of the evidence was moderate for 5-year OS, 10-year OS, 5-year CSS, 10-year CSS, 5-year RFS, 10-year RFS, tumor recurrence, decline in eGFR, and postoperative complications.
PN may provide comparable outcomes in terms of RFS & OS, and better renal function preservation although CSS was worse.
部分肾切除术（PN）治疗 T1b 期肾细胞癌（RCC）的疗效存在争议。其肿瘤学结果、术后肾功能变化和围手术期并发症尚不清楚。
我们检索了 PUBMED、EMBASE 和 Cochrane 中央注册中心 1998 年 3 月至 2018 年 3 月期间的研究，以比较 PN 与根治性肾切除术（RN）治疗 T1bRCC 的疗效。在数据提取和质量评估后，我们使用 RevMan5.2 对数据进行汇总。然后，我们使用 Stata12.0 进行敏感性分析和元回归。我们使用 GRADE 专用工具根据 GRADE 方法评估证据质量。
共有 16 项研究，涉及 33117 名患者纳入本荟萃分析。5 年总生存率（OS）、10 年 OS、5 年无复发生存率（RFS）和 10 年 RFS 无显著差异。RN 组的 5 年癌症特异性生存率（CSS）和 10 年 CSS 分别优于 PN 组，RR=1.02，P<0.05 和 RR=1.04，P<0.05。PN 在保护肾功能方面优于 RN（WMD=-9.15，95%CI：-10.30 至-7.99，P<0.05）。5 年 OS、10 年 OS、5 年 CSS、10 年 CSS、5 年 RFS、10 年 RFS、肿瘤复发、eGFR 下降和术后并发症的证据置信水平分级为中级。
PN 可能在 RFS 和 OS 方面提供相似的结果，并且保留肾功能更好，尽管 CSS 较差。
