根治性肾切除术联合或不联合淋巴结清扫术治疗pT3期肾细胞癌：一项基于倾向评分的分析
Radical Nephrectomy with or without Lymph Node Dissection for pT3 Renal Cell Carcinoma: A Propensity Score-based Analysis.
作者信息
Li Pin, Peng Cheng, Gu Liangyou, Xie Yongpeng, Nie Wenyuan, Zhang Yu, Xuan Yundong, Shen Donglai, Du Songliang, Tang Lu, Yao Yuanxin, Fan Yang, Ma Xin, Zhang Xu
机构信息
School of Medicine, Nankai University, Tianjin, People's Republic of China.
Department of Urology, State Key Laboratory of Kidney Diseases, the First Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China.
出版信息
J Cancer. 2019 May 26;10(10):2369-2375. doi: 10.7150/jca.30375. eCollection 2019.
OBJECTIVES
To study whether radical nephrectomy (RN) with lymph node dissection (LND) can benefit pT3 renal cell carcinoma (RCC) patients versus no LND under the 2018 American Joint Committee on Cancer TNM classification system. Subjects/Patients and Methods: We performed a retrospective cohort study of clinicopathological data for 245 T3 RCC patients, who underwent radical nephrectomy between January 2006 and December 2013 at our center, including 67 (27.1%) who underwent LND. The relationships between the LND and progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS) were evaluated using 1:1 propensity score (PS) matching. Then, Kaplan-Meier survival analysis and Cox regression analysis were conducted to study whether these patients can benefit from LND. Depending on the LND number, we divided the cohort into two groups for further comparation. At last, we validated the results with the TCGA database KIRC patients.
RESULTS
The median follow-up time was 4.9 years. Sixty-seven pairs of patients were screened by the PS and were further analyzed. We conducted a Cox regression with the survival data and found that the LND group, compared with the non-LND group, showed no survival benefit on PFS, CSS, and OS ( = 0.444, 0.809, and 0.816, respectively). However, the removal of 5 or more LNs showed negative effect on OS (p = 0.0387). TCGA cohort results are mostly consistent with our findings.
CONCLUSION
RN with LND cannot improve the PFS, CSS, or OS for pT3 renal cell carcinoma patients.
目的
在2018年美国癌症联合委员会TNM分类系统下，研究根治性肾切除术（RN）联合淋巴结清扫术（LND）与不进行LND相比，是否能使pT3期肾细胞癌（RCC）患者获益。研究对象/患者及方法：我们对2006年1月至2013年12月在本中心接受根治性肾切除术的245例T3期RCC患者的临床病理数据进行了回顾性队列研究，其中67例（27.1%）接受了LND。使用1:1倾向评分（PS）匹配评估LND与无进展生存期（PFS）、癌症特异性生存期（CSS）和总生存期（OS）之间的关系。然后，进行Kaplan-Meier生存分析和Cox回归分析，以研究这些患者是否能从LND中获益。根据LND数量，我们将队列分为两组进行进一步比较。最后，我们用TCGA数据库中的KIRC患者验证了结果。
结果
中位随访时间为4.9年。通过PS筛选出67对患者并进行进一步分析。我们对生存数据进行了Cox回归分析，发现LND组与非LND组相比，在PFS、CSS和OS方面均未显示出生存获益（分别为 = 0.444、0.809和0.816）。然而，切除5个或更多淋巴结对OS有负面影响（p = 0.0387）。TCGA队列结果与我们的发现基本一致。
结论
RN联合LND不能改善pT3期肾细胞癌患者的PFS、CSS或OS。
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