部分切除术与根治性切除术治疗 pT3aN0M0 期肾细胞癌：倾向评分分析。
Partial versus radical nephrectomy for the treatment of pT3aN0M0 renal cell carcinoma: A propensity score analysis.
机构信息
Department of Urology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
Department of Clinical Research, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
出版信息
Asian J Surg. 2023 Sep;46(9):3607-3613. doi: 10.1016/j.asjsur.2023.04.058. Epub 2023 May 3.
BACKGROUND
The survival benefit of partial nephrectomy (PN) in pT3a RCC patients is controversial. Here we aimed to explore the potential benefit of PN for pT3aN0M0 renal cell carcinoma (RCC).
MATERIAL AND METHODS
Data of patients with pT3aN0M0 RCC who were diagnosed between 2010 and 2012 in the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) database were retrospectively collected. Overall survival (OS) and cancer specific survival (CSS) were compared using a Cox proportional hazards model between PN and radical nephrectomy (RN) in pT3aN0M0 RCC. Propensity score (-adjusted, -stratified, -weighted, and -matched) analyses were performed to control for imbalances in individual risk factors.
RESULTS
A total of 1277 patients with pT3aN0M0 RCC were identified, of whom 200 patients were treated with PN and 1077 patients were RN. PN showed favorable OS and CSS in 0-4 cm pT3aN0M0 RCC (P < 0.05), and similar OS and CSS in 4-7 cm pT3aN0M0 RCC, compared with RN using un-adjusted analyses. The Propensity score analyses further demonstrated the survival benefit of PN compared with the RN in 0-4 cm pT3aN0M0 RCC (P < 0.05).
CONCLUSIONS
In this retrospective study, PN was associated with improved survival compared with RN in 0-4 cm pT3aN0M0 RCC. Moreover, survival was comparable between PN and RN in 4-7 cm pT3aN0M0 RCC. These data provided evidence that PN could be an alternative choice for T3aN0M0 RCC less than 7 cm. Particularly, patients with 0-4 cm pT3aN0M0 RCC might benefit from PN.
背景
部分肾切除术（PN）治疗 pT3aRCC 患者的生存获益存在争议。本研究旨在探讨 PN 治疗 pT3aN0M0 肾细胞癌（RCC）的潜在获益。
材料和方法
回顾性收集了 2010 年至 2012 年间国家癌症研究所监测、流行病学和最终结果（SEER）数据库中诊断为 pT3aN0M0RCC 的患者数据。使用 Cox 比例风险模型比较了 pT3aN0M0RCC 患者中 PN 和根治性肾切除术（RN）的总生存（OS）和癌症特异性生存（CSS）。采用倾向评分（调整、分层、加权和匹配）分析控制个体风险因素的不平衡。
结果
共纳入 1277 例 pT3aN0M0RCC 患者，其中 200 例接受 PN 治疗，1077 例接受 RN 治疗。未校正分析显示，在 0-4cm pT3aN0M0RCC 中，PN 显示出有利的 OS 和 CSS（P<0.05），而在 4-7cm pT3aN0M0RCC 中，PN 的 OS 和 CSS 与 RN 相似。倾向评分分析进一步表明，在 0-4cm pT3aN0M0RCC 中，PN 与 RN 相比具有生存获益（P<0.05）。
结论
在这项回顾性研究中，与 RN 相比，PN 在 0-4cm pT3aN0M0RCC 中与改善生存相关。此外，在 4-7cm pT3aN0M0RCC 中，PN 与 RN 的生存相当。这些数据为 PN 可能成为小于 7cmT3aN0M0RCC 的替代选择提供了证据。特别是，0-4cm pT3aN0M0RCC 患者可能从 PN 中受益。
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