与根治性肾切除术相比，对于 T2-3a 期的肾细胞癌，部分肾切除术可保留肾功能，而不增加并发症的风险。

Partial nephrectomy preserves renal function without increasing the risk of complications compared with radical nephrectomy for renal cell carcinomas of stages pT2-3a.

机构信息

Departments of, Department of, Urology and Urological Surgery, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany.

Department of, Pathology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany.

出版信息

Int J Urol. 2020 Oct;27(10):906-913. doi: 10.1111/iju.14326. Epub 2020 Aug 11.

DOI:10.1111/iju.14326

PMID:32783245

Abstract

OBJECTIVES

To compare the operative and functional result of partial and radical nephrectomy in renal cell carcinomas of stages pT2-3a.

METHODS

Consecutive patients with renal cell carcinoma of stages pT2-3a, cN0 and cM0, who underwent partial or radical nephrectomy between January 2005 and October 2019 at a tertiary care center were included. Data were collected retrospectively. End-points included severe postoperative complications (Clavien-Dindo classification ≥3), acute and chronic renal function impairment, and overall survival. Uni- and multivariable outcome analyses were based on logistic regression.

RESULTS

A total of 158 patients were included (110 radical nephrectomy and 48 partial nephrectomy). Over time, partial nephrectomy was increasingly used. A RENAL score ≥10 was the only independent predictor influencing the surgical approach (radical nephrectomy vs partial nephrectomy, odds ratio 8.62, 95% confidence interval 3.32-22.37, P < 0.001). No significant differences in complications for radical nephrectomy versus partial nephrectomy were found (12.7% vs 8.3%, P = 0.424). Renal function was better preserved in the partial nephrectomy group (the latest chronic kidney disease stage ≥3: radical nephrectomy 73% vs partial nephrectomy 41%, P = 0.005). The surgical approach was a significant factor for chronic kidney disease (odds ratio 51.07, 95% confidence interval 3.57-730.59, P = 0.004). Overall survival did not significantly differ between radical nephrectomy and partial nephrectomy (mean overall survival 85.86 months, 95% confidence interval 3.83-78.36 vs 81.28 months, 95% confidence interval 4.59-72.29, P = 0.702).

CONCLUSIONS

In selected patients, partial nephrectomy can be used in large or locally advanced renal cell carcinoma. Compared with radical nephrectomy, it allows better preservation of renal function without harboring an increased risk of severe postoperative complications.

摘要

目的

比较 T2-3a 期肾细胞癌行部分肾切除术和根治性肾切除术的手术和功能结果。

方法

连续纳入 2005 年 1 月至 2019 年 10 月在一家三级医疗中心接受 T2-3a 期、cN0 和 cM0 肾细胞癌部分或根治性肾切除术的患者。数据回顾性收集。终点包括严重术后并发症（Clavien-Dindo 分级≥3）、急性和慢性肾功能损害以及总生存。单变量和多变量结果分析基于逻辑回归。

结果

共纳入 158 例患者（根治性肾切除术 110 例，部分肾切除术 48 例）。随着时间的推移，部分肾切除术的应用逐渐增加。RENAL 评分≥10 是影响手术方式（根治性肾切除术与部分肾切除术）的唯一独立预测因素（比值比 8.62，95%置信区间 3.32-22.37，P<0.001）。根治性肾切除术与部分肾切除术的并发症无显著差异（12.7%与 8.3%，P=0.424）。部分肾切除术组肾功能保存更好（最新慢性肾脏病分期≥3：根治性肾切除术 73%与部分肾切除术 41%，P=0.005）。手术方式是慢性肾脏病的一个显著因素（比值比 51.07，95%置信区间 3.57-730.59，P=0.004）。根治性肾切除术与部分肾切除术的总生存率无显著差异（平均总生存率 85.86 个月，95%置信区间 3.83-78.36 与 81.28 个月，95%置信区间 4.59-72.29，P=0.702）。