Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Pathogenic Biology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Cancer Med. 2021 Dec;10(24):8909-8923. doi: 10.1002/cam4.4412. Epub 2021 Nov 14.
There is limited and controversial evidence on the prognosis of partial nephrectomy (PN) versus radical nephrectomy (RN) in patients with T3aN0/xM0 renal cell carcinoma (RCC) upstaged from clinical T1 RCC. In this study, we aimed to assess the prognosis difference following PN versus RN in patients with ≤7 cm T3aN0/xM0 RCC.
From the Surveillance, Epidemiology, and End Results database, a total of 3196 patients receiving treatment of PN/RN for ≤7 cm T3aN0/xM0 RCC with only extrarenal fat extension in 2010-2017 were identified. An inverse probability of treatment weighting (IPTW)-adjusted cause-specific Cox model with hazard ratio (HR) and 95% confidence interval (CI) was used for overall survival (OS) and cancer-specific survival (CSS) analyses. Sensitivity analysis was based on the propensity score matching of PN and RN groups and from the dataset of 2010-2013.
A total of 872 patients underwent PN, compared with 2324 undergoing RN. After IPTW adjustment, there was no significant difference in preoperative baseline characteristics between the PN and RN cohorts. Patients who underwent RN had worse OS (HR , 1.46; 95% CI, 1.16-1.84; p = 0.001) and comparable CSS (HR , 1.03; 95% CI, 0.64-1.66; p = 0.890) than those receiving PN in all cohorts and subgroups with T3a RCC of ≤4 cm and perinephric fat extension. Further, in patients with 4-7 cm T3a RCC with perinephric-fat invasion and all sizes of T3a RCC with sinus/perisinus fat extension, PN led to comparable OS and CSS. Sensitivity analyses validated these results.
PN provides comparable CSS and OS or even better OS than RN for patients with RCC ≤7 cm T3aN0/xM0. Although our study has some limitations, our results indicated that PN might oncologically safe for clinical T1 RCC, even confirmed a pathologically T3a upstaging post-PN.
对于从临床 T1 RCC 分期升级为 T3aN0/xM0 肾细胞癌（RCC）的患者，部分肾切除术（PN）与根治性肾切除术（RN）的预后存在有限且有争议的证据。在这项研究中，我们旨在评估在≤7cm T3aN0/xM0 RCC 患者中，PN 与 RN 后的预后差异。
从监测、流行病学和最终结果数据库中，确定了 2010-2017 年期间共 3196 例接受 PN/RN 治疗的≤7cm T3aN0/xM0 RCC 患者，这些患者仅存在肾外脂肪延伸。使用逆概率治疗加权（IPTW）调整的特定原因 Cox 模型，以风险比（HR）和 95%置信区间（CI）进行总生存（OS）和癌症特异性生存（CSS）分析。敏感性分析基于 PN 和 RN 组的倾向评分匹配，以及 2010-2013 年的数据集。
共有 872 例患者接受 PN，而 2324 例患者接受 RN。在 IPTW 调整后，PN 和 RN 队列之间的术前基线特征没有显著差异。接受 RN 的患者 OS 较差（HR，1.46；95%CI，1.16-1.84；p=0.001），CSS 无差异（HR，1.03；95%CI，0.64-1.66；p=0.890），与所有队列以及≤4cm T3a RCC 和肾周脂肪延伸的亚组一致。此外，在 4-7cm T3a RCC 伴有肾周脂肪浸润和所有大小的 T3a RCC 伴有窦周/肾周脂肪延伸的患者中，PN 导致的 OS 和 CSS 相当。敏感性分析验证了这些结果。
PN 为≤7cm T3aN0/xM0 RCC 患者提供了相当的 CSS 和 OS，甚至更好的 OS ，优于 RN。尽管我们的研究存在一些局限性，但我们的结果表明，PN 对于临床 T1 RCC 可能是一种安全的治疗方法，甚至在 PN 后证实了病理分期为 T3a。
