Zhao Kaidong, Kim Eric H, Vetter Joel M, Hsieh James J, Venkatesh Ramakrishna, Bhayani Sam B, Figenshau R Sherburne
Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P.R. China.
Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.
Mol Clin Oncol. 2020 Dec;13(6):71. doi: 10.3892/mco.2020.2141. Epub 2020 Sep 21.
The aim of the present study was to compare the survival outcomes for patients with metastatic renal cell carcinoma (mRCC) who underwent laparoscopic cytoreductive nephrectomy (CN) vs. open CN vs. targeted therapy (TT) alone at our institution. A retrospective chart review was performed at our institution for patients who underwent CN prior to TT (laparoscopic, n=48; open, n=48) or who were deemed unfit for surgery and received TT alone (n=36), between January 2007 and December 2012. Kaplan-Meier estimated survival and Cox proportional hazards analyses were performed. Laparoscopic CN was associated with significantly longer survival compared with open CN or TT alone (median survival 24 vs. <12 months, respectively; P<0.01). On multivariate analysis, laparoscopic CN was an independent predictor of survival [hazard ratio (HR)=0.48, P<0.01), controlling for preoperative risk factors, while survival was similar between open CN and TT alone (HR=0.85, P=0.54). In our experience, laparoscopic CN appears to be a significant predictor of survival in mRCC. Selection bias of the surgeon for patients with improved survival may account for clinical variables that were otherwise difficult to quantify. For patients who were not candidates for laparoscopic CN, open CN did not confer a survival benefit over TT alone, while it was associated with increased morbidity.
本研究的目的是比较在我们机构接受腹腔镜减瘤性肾切除术（CN）、开放性CN或单纯靶向治疗（TT）的转移性肾细胞癌（mRCC）患者的生存结局。2007年1月至2012年12月期间，我们机构对在接受TT之前接受CN的患者（腹腔镜手术，n = 48；开放手术，n = 48）或被认为不适合手术并仅接受TT的患者（n = 36）进行了回顾性病历审查。进行了Kaplan-Meier生存估计和Cox比例风险分析。与开放性CN或单纯TT相比，腹腔镜CN与显著更长的生存期相关（中位生存期分别为24个月和<12个月；P<0.01）。多变量分析显示，腹腔镜CN是生存的独立预测因素[风险比（HR）=0.48，P<0.01]，校正了术前危险因素，而开放性CN和单纯TT的生存期相似（HR = 0.85，P = 0.54）。根据我们的经验，腹腔镜CN似乎是mRCC患者生存的重要预测因素。外科医生对生存期改善患者的选择偏倚可能解释了其他难以量化的临床变量。对于不适合腹腔镜CN的患者，开放性CN与单纯TT相比并未带来生存获益，同时其与发病率增加相关。
