Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China.
Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China.
BMJ Open. 2021 Dec 24;11(12):e051622. doi: 10.1136/bmjopen-2021-051622.
Nephron-sparing surgery (NSS) is widely applied for small renal masses. However, the indication of NSS in patients with localised renal cell carcinoma (RCC) with high anatomical complexity is controversial. Thus, we compare functional and oncological outcomes, and safety of NSS versus radical nephrectomy (RN) in patients with localised RCC with high anatomical complexity Radius, Exophytic/endophytic, Nearness, Anterior/posterior, Location. (R.E.N.A.L.) score ≥10.
We evaluated 575 patients with localised RCC that underwent NSS or RN at our centre between January 2013 and December 2018. Demographic characteristics, comorbidities, tumour data, surgery procedure, perioperative data and survival data were recorded. After propensity score matching, the variables were compared by binary paired logistic regression. The change in estimated glomerular filtration rate (eGFR) was compared with covariance analysis adjusted for baseline value. Recurrence and survival were calculated using Kaplan-Meier curves with log-rank tests. P<0.05 was considered to be statistically significant.
In the matched group, NSS showed lower eGFR loss compared with the RN group (17.81 mL/min/1.73 m vs 28.28 mL/min/1.73 m, p<0.001). Moreover, the recurrence-free survival (p=0.002), cardiocerebrovascular disease-specific survival (p=0.015) and overall survival (p=0.017) of patients with NSS were better than those that underwent RN. Cancer-specific survival in both groups showed no difference (p=0.323). The incidence of minor and major complications in the two groups showed no difference (p=0.144, p=0.108).
NSS resulted in better preservation of renal function and oncological outcomes compared with RN, with acceptable complications. These findings could help improve clinical decision making for patients with localised RCC with high anatomical complexity.
ChiCTR2000040652.
保肾手术（NSS）广泛应用于小肾肿瘤。然而，对于局部肾细胞癌（RCC）且解剖结构复杂的患者，NSS 的适应证仍存在争议。因此，我们比较了局部 RCC 且解剖结构复杂（R.E.N.A.L. 评分≥10）患者行保肾手术（NSS）与根治性肾切除术（RN）的功能和肿瘤学结局以及安全性。
我们评估了 2013 年 1 月至 2018 年 12 月期间在我们中心接受 NSS 或 RN 的 575 例局部 RCC 患者。记录人口统计学特征、合并症、肿瘤数据、手术程序、围手术期数据和生存数据。在进行倾向评分匹配后，通过二项配对逻辑回归比较变量。通过协方差分析，对基线值进行调整后比较估算肾小球滤过率（eGFR）的变化。使用 Kaplan-Meier 曲线和对数秩检验计算复发和生存情况。P<0.05 被认为具有统计学意义。
在匹配组中，与 RN 组相比，NSS 组的 eGFR 损失更低（17.81mL/min/1.73m 比 28.28mL/min/1.73m，P<0.001）。此外，NSS 组的无复发生存率（p=0.002）、心脑血管疾病特异性生存率（p=0.015）和总生存率（p=0.017）均优于 RN 组。两组的癌症特异性生存率无差异（p=0.323）。两组的轻微和严重并发症发生率无差异（p=0.144，p=0.108）。
与 RN 相比，NSS 可更好地保留肾功能和肿瘤学结局，且并发症发生率可接受。这些发现有助于改善局部解剖结构复杂的 RCC 患者的临床决策。
ChiCTR2000040652。
