Davaro Facundo, Roberts Jacob, May Allison, McFerrin Coleman, Siddiqui Sameer, Hamilton Zachary
Division of Urology, Department of Surgery, Saint Louis University, 3635 Vista Ave, 3rd Floor Desloge Towers, St. Louis, MO, 63110, USA.
Saint Louis University School of Medicine, St Louis, MO, USA.
J Robot Surg. 2020 Jun;14(3):447-454. doi: 10.1007/s11701-019-01015-z. Epub 2019 Aug 27.
Partial nephrectomy is the mainstay of treatment for localized kidney cancer. A proportion of patients are upstaged post-operatively to locally advanced disease (pT3a). We aimed to identify the incidence of upstaging to pT3a during partial nephrectomy and its relationship to a robotic approach. The National Cancer Database was queried for patients diagnosed with cT1M0 disease between 2010 and 2015 who underwent an open or robotic partial nephrectomy with final stage pT1-3a. Our primary outcome was rate of upstaging to pT3a in patients undergoing partial nephrectomy and secondary outcomes were stage migration, rate of positive margins, and overall survival (OS). The relationship between open and robotic surgery was examined. Logistical regression and Kaplan-Meier analyses were performed. Of 68,976 patients identified, 5.9% of patients were upstaged from cT1 to pT3a post-operatively. The incidence of upstaging to pT3a disease has increased from 5.7% in 2010 to 6.9% in 2015. Similarly, the proportion of patients undergoing a robotic approach is also increasing (31.6-64.4%); however, a robotic approach is not associated with pT3a upstaging on multivariable analysis. The probability of being upstaged was significantly proportional to increasing tumor size (OR 2.634-11.641, p < 0.05). pT3a disease was associated with a significant increase in positive margins (10.7% vs 5.0%, p < 0.001). Interestingly, pT3a patients with positive margin had worsened survival (5-year OS 75.5% vs 65.9%, p < 0.001). A robotic surgical approach to partial nephrectomy does not increase risk of upstaging to pT3a disease. Those who are upstaged have increased risk of positive margins and associated risk of decreased survival.
部分肾切除术是局限性肾癌治疗的主要方法。一部分患者术后分期上调至局部进展期疾病（pT3a）。我们旨在确定部分肾切除术中上调至pT3a的发生率及其与机器人手术方式的关系。查询国家癌症数据库中2010年至2015年间诊断为cT1M0疾病且接受开放性或机器人辅助部分肾切除术且最终分期为pT1 - 3a的患者。我们的主要结局是接受部分肾切除术患者上调至pT3a的发生率，次要结局是分期迁移、切缘阳性率和总生存期（OS）。研究了开放性手术与机器人手术之间的关系。进行了逻辑回归和Kaplan - Meier分析。在68976例确定的患者中，5.9%的患者术后从cT1上调至pT3a。上调至pT3a疾病的发生率从2010年的5.7%增加到2015年的6.9%。同样，接受机器人手术方式的患者比例也在增加（31.6% - 64.4%）；然而，在多变量分析中，机器人手术方式与上调至pT3a无关。上调分期的概率与肿瘤大小增加显著相关（OR 2.634 - 11.641，p < 0.05）。pT3a疾病与切缘阳性率显著增加相关（10.7%对5.0%，p < 0.001）。有趣的是，切缘阳性的pT3a患者生存期较差（5年总生存期75.5%对65.9%，p < 0.001）。机器人辅助部分肾切除术不会增加上调至pT3a疾病的风险。分期上调的患者切缘阳性风险增加且生存期降低相关风险增加。
