Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea.
Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju, Korea.
Investig Clin Urol. 2022 Mar;63(2):126-139. doi: 10.4111/icu.20210361.
To evaluate the clinical efficacy and safety of tumor enucleation (TE) compared with partial nephrectomy (PN) for T1 renal cell carcinoma.
According to protocol, we searched multiple data sources for published and unpublished randomized controlled trials and nonrandomized studies (NRSs) in any language. We performed systematic review and meta-analysis according to the Cochrane Handbook for Systematic Reviews of Interventions and rated the certainty of the evidence (CoE) using the GRADE framework.
We are uncertain about the effects of TE on perioperative (mean difference [MD] 3.38, 95% CI 1.52 to 5.23; I²=68%; 4 NRSs; 942 participants; very low CoE) and long-term (MD 2.31, 95% CI -1.40 to 6.01; I²=57%; 4 NRSs; 542 participants; very low CoE) residual renal function. TE may result in little to no difference in short-term residual renal function (MD 1.04, 95% CI 0.25 to 1.83; I²=0%; 2 NRSs; 256 participants; low CoE). We are uncertain about the effects of TE on cancer-specific mortality (risk ratio [RR] 0.90, 95% CI: 0.11 to 7.28; I²=0%; 2 NRSs; 551 participants; very low CoE) and major adverse events (RR 0.48, 95% CI: 0.30 to 0.79; I²=0%; 10 NRS; 2,360 participants; very low CoE).
While TE appears to have similar effects on short term postoperative residual renal function, there were uncertainties on mortality and major adverse events. However, we need rigorous RCTs to elucidate the effects of TE as the evidence stems mostly from NRSs.
评估肿瘤剜除术（TE）与部分肾切除术（PN）治疗 T1 期肾细胞癌的临床疗效和安全性。
根据方案，我们以任何语言检索了多个数据来源，以查找已发表和未发表的随机对照试验和非随机研究（NRS）。我们根据 Cochrane 干预系统评价手册进行了系统评价和荟萃分析，并使用 GRADE 框架对证据确定性（CoE）进行了评级。
我们不确定 TE 对围手术期（平均差值 [MD] 3.38，95%CI 1.52 至 5.23；I²=68%；4 项 NRS；942 名参与者；非常低的 CoE）和长期（MD 2.31，95%CI-1.40 至 6.01；I²=57%；4 项 NRS；542 名参与者；非常低的 CoE）残余肾功能的影响。TE 可能对短期残余肾功能几乎没有影响（MD 1.04，95%CI 0.25 至 1.83；I²=0%；2 项 NRS；256 名参与者；低 CoE）。我们不确定 TE 对癌症特异性死亡率（风险比 [RR] 0.90，95%CI：0.11 至 7.28；I²=0%；2 项 NRS；551 名参与者；非常低的 CoE）和主要不良事件（RR 0.48，95%CI：0.30 至 0.79；I²=0%；10 项 NRS；2360 名参与者；非常低的 CoE）的影响。
虽然 TE 似乎对短期术后残余肾功能有相似的影响，但在死亡率和主要不良事件方面存在不确定性。然而，我们需要严格的 RCT 来阐明 TE 的效果，因为证据主要来自 NRS。
