Tan Wei Shen, Koelker Mara, Campain Nicholas, Cole Alexander P, Labban Muhieddine, Mossanen Matthew, Barod Ravi, Kibel Adam S, Chang Steven L, Bex Axel, Trinh Quoc-Dien
Division of Surgery and Interventional Science, Department of Urology, University College London, London, UK; Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Center for Surgery and Public Health, Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Eur Urol Focus. 2023 Mar;9(2):333-335. doi: 10.1016/j.euf.2022.09.018. Epub 2022 Oct 12.
Partial nephrectomy (PN) is recommended for renal cell carcinoma (RCC) of <4 cm. We hypothesized that there is no difference in all-cause mortality (ACM) between cT1a, cT1b, and cT3a <4 cm RCC following PN. The National Cancer Database was interrogated to identify patients aged <60 yr with a Charlson comorbidity index ≤1 diagnosed between 2004 and 2017. Cox proportional-hazard models stratified for cT stage were used to predict 10-yr ACM. A total of 30 195 patients (25 121 cT1a, 4884 cT1b, and 190 cT3a <4 cm) who underwent PN with median follow-up of 64.36 mo (interquartile range 42.91-93.77) were included. Cox analysis revealed no significant difference in 10-yr ACM between cT1a and cT3a <4 cm (hazard ratio [HR] 1.05, 95% confidence interval [CI] 0.58-1.90; p = 0.88). However, the cT1b group had higher ACM (HR 1.31, 95% CI 1.15-1.48; p < 0.01). The positive surgical margin (PSM) rate was higher for cT3a <4 cm than for cT1a tumors (14.2% vs 6.3%; p < 0.01). However, there was no difference in 10-yr ACM rate between cT1a and cT3a <4 cm (10.9% vs 9.7%; p = 0.42). Our results suggest that PN is an option for cT3a RCC <4 cm, particularly in cases in which maximum nephron preservation is essential, such as patients with chronic kidney disease or a solitary kidney, although a higher PSM risk should be appreciated. PATIENT SUMMARY: We found that partial removal of the kidney for localized advanced kidney cancer is safe. The rate of surgical margins positive for the presence of tumor is higher in localized advanced kidney cancer than for less advanced cancers, but there was no difference in 10-year predicted mortality.
对于直径小于4厘米的肾细胞癌（RCC），推荐行部分肾切除术（PN）。我们假设，直径小于4厘米的cT1a、cT1b和cT3a期RCC患者接受PN后，全因死亡率（ACM）无差异。检索国家癌症数据库，以确定2004年至2017年间确诊的年龄小于60岁、Charlson合并症指数≤1的患者。采用按cT分期分层的Cox比例风险模型预测10年ACM。共有30195例患者（25121例cT1a期、4884例cT1b期和190例直径小于4厘米的cT3a期）接受了PN，中位随访时间为64.36个月（四分位间距42.91 - 93.77）。Cox分析显示，直径小于4厘米的cT1a期和cT3a期患者10年ACM无显著差异（风险比[HR] 1.05，95%置信区间[CI] 0.58 - 1.90；p = 0.88）。然而，cT1b组的ACM更高（HR 1.31，95% CI 1.15 - 1.48；p < 0.01）。直径小于4厘米的cT3a期肿瘤的阳性手术切缘（PSM）率高于cT1a期肿瘤（14.2%对6.3%；p < 0.01）。然而，直径小于4厘米的cT1a期和cT3a期患者的10年ACM率无差异（10.9%对9.7%；p = 0.42）。我们的结果表明，PN是直径小于4厘米的cT3a期RCC的一种选择，特别是在最大程度保留肾单位至关重要的情况下，如慢性肾脏病患者或单肾患者，尽管应认识到PSM风险较高。患者总结：我们发现，对局限性晚期肾癌进行部分肾切除是安全的。局限性晚期肾癌的肿瘤阳性手术切缘率高于低度进展性癌症，但10年预测死亡率无差异。
