非转移性 pT3a 期肾癌患者行部分肾切除术与根治性肾切除术的比较：一项基于人群的研究。
Partial vs. radical nephrectomy in non-metastatic pT3a kidney cancer patients: a population-based study.
机构信息
Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy -
Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy.
出版信息
Minerva Urol Nephrol. 2022 Aug;74(4):445-451. doi: 10.23736/S2724-6051.22.04680-8. Epub 2022 Feb 11.
BACKGROUND
The aim of this study was to test for differences in cancer specific mortality (CSM) rates between radical nephrectomy (RN) and partial nephrectomy (PN) in pT3a nmRCC patients.
METHODS
Within the surveillance, epidemiology, and end results database (2005-2016), 13,177 pT3a patients treated with either PN or RN were identified. Before and after 1:2 ratio propensity score (PS)-match between PN and RN patients, cumulative incidence plot and competing risks regression (CRR) were used to test differences in CSM and other cause mortality (OCM) rates.
RESULTS
Relative to PN (N.=1615, 22.5%), RN patients harbored higher tumor size (72 vs. 38 mm; >70 mm 51 vs.10%), of more aggressive histology, collecting duct (0.4 vs. 0.2%) and sarcomatoid (2.3 vs.0.8%), of higher grade (51.0 vs. 37.5%). After PS-matching and OCM adjustment, 5-year CSM was 3-fold higher after RN than PN (P<0.01). Similarly, after PS matching and CSM adjustment, also 5-year OCM rates were higher after RN (HR: 1.59, P=0.0003).
CONCLUSIONS
PN does not appear to compromise the oncological outcomes in patients with pT3a or high-grade renal masses when compared with RN. Therefore, these concerns should not deter a surgeon from attempting PN when otherwise technically feasible.
背景
本研究旨在检测在 pT3a nmRCC 患者中，根治性肾切除术（RN）和部分肾切除术（PN）的癌症特异性死亡率（CSM）是否存在差异。
方法
在监测、流行病学和最终结果数据库（2005-2016 年）中，确定了 13177 例接受 PN 或 RN 治疗的 pT3a 患者。在对 PN 和 RN 患者进行 1:2 比例倾向评分（PS）匹配之前和之后，使用累积发生率图和竞争风险回归（CRR）来检测 CSM 和其他原因死亡率（OCM）率的差异。
结果
与 PN 相比（N=1615，22.5%），RN 患者的肿瘤体积更大（72 比 38 毫米；>70 毫米 51 比 10%），组织学更具侵袭性，集合管（0.4 比 0.2%）和肉瘤样（2.3 比 0.8%），分级更高（51.0 比 37.5%）。在 PS 匹配和 OCM 调整后，RN 后 5 年 CSM 是 PN 的 3 倍（P<0.01）。同样，在 PS 匹配和 CSM 调整后，RN 后 5 年 OCM 率也更高（HR：1.59，P=0.0003）。
结论
与 RN 相比，PN 似乎不会影响 pT3a 或高级别肾肿瘤患者的肿瘤学结果。因此，这些担忧不应阻止外科医生在技术上可行的情况下尝试 PN。
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