A.C. Camargo Cancer Center, Rua Antônio Prudente 211, Liberdade, São Paulo, 01509-010, Brazil.
Pasteur Hospital, Montevideo, Uruguay.
BMC Urol. 2020 Jul 2;20(1):85. doi: 10.1186/s12894-020-00649-8.
To evaluate demographic, clinical and pathological characteristics of small renal masses (SRM) (≤ 4 cm) in a Latin-American population provided by LARCG (Latin-American Renal Cancer Group) and analyze predictors of survival, recurrence and metastasis.
A multi-institutional retrospective cohort study of 1523 patients submitted to surgical treatment for non-metastatic SRM from 1979 to 2016. Comparisons between radical (RN) or partial nephrectomy (PN) and young or elderly patients were performed. Kaplan-Meier curves and log-rank tests estimated 10-year overall survival. Predictors of local recurrence or metastasis were analyzed by a multivariable logistic regression model.
PN and RN were performed in 897 (66%) and 461 (34%) patients. A proportional increase of PN cases from 48.5% (1979-2009) to 75% (after 2009) was evidenced. Stratifying by age, elderly patients (≥ 65 years) had better 10-year OS rates when submitted to PN (83.5%), than RN (54.5%), p = 0.044. This disparity was not evidenced in younger patients. On multivariable model, bilaterality, extracapsular extension and ASA (American Society of Anesthesiologists) classification ≥3 were predictors of local recurrence. We did not identify significant predictors for distant metastasis in our series.
PN is performed in Latin-America in a similar proportion to developed areas and it has been increasing in the last years. Even in elderly individuals, if good functional status, sufficiently fit to surgery, and favorable tumor characteristics, they should be encouraged to perform PN. Intending to an earlier diagnosis of recurrence or distant metastasis, SRM cases with unfavorable characteristics should have a more rigorous follow-up routine.
评估拉丁美洲人群中由 LARCG（拉丁美洲肾癌组）提供的小肾肿瘤（SRM）（≤4cm）的人口统计学、临床和病理特征，并分析生存、复发和转移的预测因素。
对 1979 年至 2016 年间接受手术治疗的 1523 例非转移性 SRM 患者进行了多机构回顾性队列研究。对根治性肾切除术（RN）或部分肾切除术（PN）与年轻或老年患者进行了比较。Kaplan-Meier 曲线和对数秩检验估计了 10 年的总生存率。通过多变量逻辑回归模型分析局部复发或转移的预测因素。
1523 例患者中，897 例（66%）行 PN，461 例（34%）行 RN。证据表明，PN 例数从 1979 年至 2009 年的 48.5%呈比例增加至 2009 年后的 75%。按年龄分层，老年（≥65 岁）患者接受 PN（83.5%）的 10 年 OS 率优于 RN（54.5%），p=0.044。在年轻患者中未发现这种差异。多变量模型显示，双侧性、包膜外延伸和 ASA（美国麻醉师协会）分级≥3 是局部复发的预测因素。在我们的研究中，没有发现远处转移的显著预测因素。
PN 在拉丁美洲的开展比例与发达国家相似，近年来一直在增加。即使是老年患者，如果功能状态良好，手术适应性强，肿瘤特征有利，也应鼓励他们进行 PN。为了更早地诊断复发或远处转移，具有不利特征的 SRM 病例应进行更严格的随访。
