Tilley Derek, Remondini Taylor, Van Tuyl John, Pak Wendy, Gotto Geoffrey T
Alberta Health Services, Cancer Control, Holy Cross Centre, Calgary, AB, Canada.
Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Res Rep Urol. 2020 Mar 4;12:85-90. doi: 10.2147/RRU.S212584. eCollection 2020.
When technically feasible, partial nephrectomy (pN) is preferred over radical nephrectomy (rN) due to similar oncological control with preservation of renal function. Here, we evaluate the incorporation of pN into practice for small renal masses and examine the associated outcomes.
We included patients who had undergone either a partial or radical nephrectomy in Alberta, Canada for renal cell carcinomas with pathology tumor stage T1a between 2002 and 2014 (N=1449). Patients were excluded if they had multiple tumors or if they were on dialysis prior to nephrectomy.
pN use increased over the duration of the study period. Patients treated after the introduction of guidelines (2007) recommending the use of pN were significantly more likely to receive a pN (OR: 2.709, 95% CI: 1.944-3.775; p<0.001) after adjusting for baseline estimated glomerular filtration rate (GFR), age, and sex. Patients who received rN were at significantly increased risk of death (HR: 1.528, 95% CI: 1.029-2.270; p=0.036) after controlling for baseline GFR, age, and sex. Baseline GFR significantly affected odds of receiving pN (p<0.050) in the entire cohort, but subgroup analysis of more recently diagnosed patients (2011-2014) showed that only patients with kidney failure (GFR <15) were less likely to have received pN.
The utilization of pN for patients with pT1a renal cell carcinoma has increased significantly over time and has been accelerated by the introduction of guideline recommendations. Patients treated with pN over the study period had superior overall survival.
在技术可行的情况下，部分肾切除术（pN）由于在肿瘤学控制方面与根治性肾切除术（rN）相似且能保留肾功能，因此更受青睐。在此，我们评估pN在小肾肿块治疗中的实际应用情况并检查相关结果。
我们纳入了2002年至2014年在加拿大艾伯塔省因病理肿瘤分期为T1a的肾细胞癌而接受部分或根治性肾切除术的患者（N = 1449）。如果患者有多个肿瘤或在肾切除术前接受透析，则将其排除。
在研究期间，pN的使用有所增加。在调整基线估计肾小球滤过率（GFR）、年龄和性别后，在引入推荐使用pN的指南（2007年）后接受治疗的患者接受pN的可能性显著更高（OR：2.709，95% CI：1.944 - 3.775；p < 0.001）。在控制基线GFR、年龄和性别后，接受rN的患者死亡风险显著增加（HR：1.528，95% CI：1.029 - 2.270；p = 0.036）。基线GFR在整个队列中显著影响接受pN的几率（p < 0.050），但对最近诊断的患者（2011 - 2014年）进行的亚组分析表明，只有肾衰竭（GFR < 15）的患者接受pN的可能性较小。
随着时间的推移，pT1a肾细胞癌患者对pN的利用率显著增加，并且指南建议的引入加速了这一进程。在研究期间接受pN治疗的患者总体生存率更高。
