Zhang Lijin, Wu Bin, Zha Zhenlei, Qu Wei, Zhao Hu, Yuan Jun
Department of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, Jiangyin, China.
Department of Pharmacy, Affiliated Jiang-yin Hospital of the Southeast University Medical College, Jiangyin, China.
Front Oncol. 2020 Mar 6;10:286. doi: 10.3389/fonc.2020.00286. eCollection 2020.
Published data from individual studies present conflicting evidence about the relationship between clinicopathological risk factors and oncological outcomes in renal cell cancer (RCC) following nephron-sparing surgery (NSS). This study was conducted to explore the potential risk factors for RCC progress after NSS. Studies published in PubMed, Web of Science, and EMBASE were systematically reviewed from inception to March 2019 to determine risk factors for RCC following NSS. The predictive ability of identified predictors was assessed by hazard ratios (HRs) with 95% confidence intervals (CIs). A fixed-effect or random-effect was used to pool the estimates. Subgroup analyses were performed to explore the source of heterogeneity. Seventeen studies including 38,522 patients with RCC were analyzed. The meta-analysis indicated that positive surgical margin (pooled HR = 1.47; 95% CI:1.24-1.73; < 0.001), higher Fuhrman grade (pooled HR = 1.58; 95% CI:1.10-2.28; = 0.013), higher pathological stage (pooled HR = 1.72; 95% CI:1.40-2.12; < 0.001) and large tumor size (pooled HR = 1.09; 95% CI:1.03-1.16; = 0.003) were significantly associated with recurrence risk. However, age (pooled HR = 1.00; 95% CI: 1.00-1.01; = 0.257), sex (male vs. female) (pooled HR = 1.04; 95% CI: 0.89-1.21; = 0.605) and surgical approach (laparoscope vs. open) (pooled HR = 0.80; 95% CI: 0.59-1.07; = 0.129) had no effect on recurrence after NSS. In addition, we found that positive surgical margin was significantly associated with recurrence-free survival (pooled HR = 1.87; 95% CI: 1.32-2.66; < 0.001) and overall mortality (pooled HR = 1.15; 95% CI: 1.07-1.23; < 0.001), as well as large tumor size for recurrence-free survival (pooled HR = 1.18; 95% CI: 1.06-1.30; = 0.002)and overall mortality (pooled HR = 1.01; 95% CI: 1.00-1.02; = 0.004). Unfavorable pathological characteristics were distinctly related to worse oncological outcomes in RCC patients following NSS. These results may contribute to proposed prediction models for RCC patients to aid in counseling and risk stratification.
关于保留肾单位手术（NSS）后肾细胞癌（RCC）的临床病理危险因素与肿瘤学结局之间的关系，各单项研究发表的数据存在相互矛盾的证据。本研究旨在探讨NSS后RCC进展的潜在危险因素。对PubMed、科学网和EMBASE上发表的研究进行了系统回顾，时间跨度从研究起始至2019年3月，以确定NSS后RCC的危险因素。通过带有95%置信区间（CIs）的风险比（HRs）评估已识别预测因素的预测能力。采用固定效应或随机效应来汇总估计值。进行亚组分析以探究异质性的来源。分析了17项研究，共纳入38522例RCC患者。荟萃分析表明，手术切缘阳性（合并HR = 1.47；95% CI：1.24 - 1.73；P < 0.001）、福尔曼分级较高（合并HR = 1.58；95% CI：1.10 - 2.28；P = 0.013）、病理分期较高（合并HR = 1.72；95% CI：1.40 - 2.12；P < 0.001）和肿瘤体积较大（合并HR = 1.09；95% CI：1.03 - 1.16；P = 0.003）与复发风险显著相关。然而，年龄（合并HR = 1.00；95% CI：1.00 - 1.01；P = 0.257）、性别（男性与女性）（合并HR = 1.04；95% CI：0.89 - 1.21；P =
