UCL Division of Surgical and Interventional Science, Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK.
Barts Cancer Institute, Queen Mary University of London, London, UK.
BJU Int. 2021 Sep;128(3):386-394. doi: 10.1111/bju.15415. Epub 2021 Apr 26.
To investigate whether pT1 renal cell carcinoma (RCC) should be followed differently after partial (PN) or radical nephrectomy (RN) based on a retrospective analysis of a multicentre database (RECUR).
A retrospective study was conducted in 3380 patients treated for nonmetastatic RCC between January 2006 and December 2011 across 15 centres from 10 countries, as part of the RECUR database project. For patients with pT1 clear-cell RCC, patterns of recurrence were compared between RN and PN according to recurrence site. Univariate and multivariate models were used to evaluate the association between surgical approach and recurrence-free survival (RFS) and cancer-specific mortality (CSM).
From the database 1995 patients were identified as low-risk patients (pT1, pN0, pNx), of whom 1055 (52.9%) underwent PN. On multivariate analysis, features associated with worse RFS included tumour size (hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.14-1.39; P < 0.001), nuclear grade (HR 2.31, 95% CI 1.73-3.08; P < 0.001), tumour necrosis (HR 1.5, 95% CI 1.03-2.3; P = 0.037), vascular invasion (HR 2.4, 95% CI 1.3-4.4; P = 0.005) and positive surgical margins (HR 4.4, 95% CI 2.3-8.5; P < 0.001). Kaplan-Meier analysis of CSM revealed that the survival of patients with recurrence after PN was significantly better than those with recurrence after RN (P = 0.02). While the above-mentioned risk factors were associated with prognosis, type of surgery alone was not an independent prognostic variable for RFS nor CSM. Limitations include the retrospective nature of the study.
Our results showed that follow-up protocols should not rely solely on stage and type of primary surgery. An optimized regimen should also include validated risk factors rather than type of surgery alone to select the best imaging method and to avoid unnecessary imaging. A follow-up of more than 3 years should be considered in patients with pT1 tumours after RN. A novel follow-up strategy is proposed.
通过对多中心数据库（RECUR）的回顾性分析，研究局部（PN）或根治性（RN）肾部分切除术（PN）后 pT1 肾细胞癌（RCC）是否应采用不同的随访策略。
对 2006 年 1 月至 2011 年 12 月期间来自 10 个国家的 15 个中心的 3380 例非转移性 RCC 患者进行回顾性研究，这些患者是 RECUR 数据库项目的一部分。对于 pT1 透明细胞 RCC 患者，根据复发部位比较 RN 和 PN 后复发模式。采用单变量和多变量模型评估手术方式与无复发生存（RFS）和癌症特异性死亡率（CSM）之间的关系。
从数据库中确定了 1995 例低危患者（pT1、pN0、pNx），其中 1055 例（52.9%）接受了 PN。多变量分析显示，与 RFS 较差相关的特征包括肿瘤大小（风险比 [HR] 1.32，95%置信区间 [CI] 1.14-1.39；P < 0.001）、核分级（HR 2.31，95% CI 1.73-3.08；P < 0.001）、肿瘤坏死（HR 1.5，95% CI 1.03-2.3；P = 0.037）、血管侵犯（HR 2.4，95% CI 1.3-4.4；P = 0.005）和阳性切缘（HR 4.4，95% CI 2.3-8.5；P < 0.001）。Kaplan-Meier 分析显示，PN 后复发患者的生存率明显优于 RN 后复发患者（P = 0.02）。虽然上述危险因素与预后相关，但手术类型本身并不是 RFS 或 CSM 的独立预后变量。局限性包括研究的回顾性。
我们的结果表明，随访方案不应仅依赖于分期和原发手术类型。优化方案还应包括经验证的危险因素，而不仅仅是手术类型，以选择最佳影像学方法并避免不必要的影像学检查。RN 后 pT1 肿瘤患者应考虑随访超过 3 年。提出了一种新的随访策略。
