Shu Fan, Hao Yichang, Zhang Zhanyi, Deng Shaohui, Zhang Hongxian, Liu Lei, Wang Guoliang, Tian Xiaojun, Zhao Lei, Ma Lulin, Zhang Shudong
Department of Urology, Peking University Third Hospital, Beijing 100191, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2024 Aug 18;56(4):667-672. doi: 10.19723/j.issn.1671-167X.2024.04.020.
To investigate the postoperative renal function and oncologic outcomes of cystic renal cell carcinoma with partial nephrectomy, and to compared the single-center data on surgical outcomes with the Surveillance, Epidemiology, and End Results (SEER) database.
This was a retrospective study that included the patients with cystic renal cell carcinoma who underwent partial nephrectomy in the Department of Urology, Peking University Third Hospital (PUTH) from 2010 to 2023. The clinical data and depicting baseline characteristics were collected. Renal dynamic imaging and the Chinese Coefficients for Chronic Kidney Disease Epidemiology Collaboration (C-CKD-EPI) formulae were used to calculate the estimated glomerular filtration rate (eGFR). The renal function curves over time were then plotted, and the patients were followed-up to record their survival status. Cases of cystic renal cell carcinoma in the SEER database between 2000 and 2020 were included, propensity score matching (PSM) was performed to balance the differences between SEER cohort and PUTH cohort, and the cancer-specific survival (CSS) curves for both groups were plotted and statistical differences were calculated by the Kaplan-Meier method.
A total of 38 and 385 patients were included in the PUTH cohort and SEER cohort, respectively, and 31 and 72 patients were screened in each cohort after PSM. Of the baseline characteristics, only tumor size (=0.042) was found to differ statistically between the two groups. There was no statistically significant difference between the two cohorts in terms of CSS after PSM (=0.556). The median follow-up time in the SEER cohort was 112.5 (65, 152) months and a 10-year survival rate of 97.2%, while the PUTH cohort had a median follow-up of 57.0 (20, 1 172) months and a 10-year survival rate of 100.0%. There was no statistically significant difference between eGFR determined by preoperative renal dynamic imaging and the results of the C-CKD-EPI formulae based on creatinine estimation (=0.073). There was a statistically significant difference in eGFR among the preoperative, short-term postoperative, and long-term postoperative ( < 0.001), which was characterized by the presence of a decline in renal function in the short-term postoperative period and the recovery of renal function in the long-term period.
Partial nephrectomy for cystic renal cell carcinoma is safe and feasible with favorable renal function and oncologic outcomes.
探讨囊性肾细胞癌行肾部分切除术后的肾功能及肿瘤学结局，并将单中心手术结局数据与监测、流行病学和最终结果（SEER）数据库进行比较。
本研究为回顾性研究，纳入2010年至2023年在北京大学第三医院泌尿外科接受肾部分切除术的囊性肾细胞癌患者。收集临床资料并描述基线特征。采用肾动态显像和中国慢性肾脏病流行病学合作组（C-CKD-EPI）公式计算估计肾小球滤过率（eGFR）。然后绘制肾功能随时间变化的曲线，并对患者进行随访以记录其生存状态。纳入SEER数据库2000年至2020年的囊性肾细胞癌病例，进行倾向评分匹配（PSM）以平衡SEER队列和北医三院队列之间的差异，绘制两组的癌症特异性生存（CSS）曲线，并采用Kaplan-Meier法计算统计学差异。
北医三院队列和SEER队列分别纳入38例和385例患者，PSM后各队列筛选出31例和72例患者。在基线特征方面，仅肿瘤大小（P=0.042）在两组间存在统计学差异。PSM后两组在CSS方面无统计学差异（P=0.556）。SEER队列的中位随访时间为112.5（65，152）个月，10年生存率为97.2%，而北医三院队列的中位随访时间为57.0（20，1172）个月，10年生存率为100.0%。术前肾动态显像测定的eGFR与基于肌酐估算的C-CKD-EPI公式结果之间无统计学差异（P=0.073）。术前、术后短期和术后长期的eGFR存在统计学差异（P<0.001），其特点是术后短期内肾功能下降，长期肾功能恢复。
囊性肾细胞癌行肾部分切除术安全可行，肾功能及肿瘤学结局良好。
