Hauser Nicholas, Giakas Julian, Robinson Hunter, Davaro Facundo, Hamilton Zachary
Saint Louis University School of Medicine, 1402 S Grand Blvd, St. Louis, MO 63104, USA.
Geisinger Medical Center, 100 N Academy Ave, Danville, PA 17822, USA.
J Clin Med. 2024 Sep 27;13(19):5767. doi: 10.3390/jcm13195767.
Cytoreductive nephrectomy for metastatic renal cell carcinoma (mRCC) is a standard of care. Partial nephrectomy (PN) in the setting of metastatic disease is an uncommon occurrence, and we aimed to characterize its utilization in a modern cohort.
The National Cancer Database was reviewed for patients with mRCC from 2010 to 2017. Patients with cTanyNanyM1 who underwent cytoreductive surgery in the form of PN or radical nephrectomy (RN) were compiled. Our primary outcome was survival outcome for patients who underwent PN compared to RN. Secondary outcomes included 30-day readmission, length of stay, and survival outcomes.
A total of 13,896 patients with mRCC who underwent cytoreductive surgery were identified. In total, 13,242 underwent RN and 654 underwent PN. The RN population was more likely to have cN positive disease, while the PN population was more likely to have cT1 disease. Length of stay, readmission and 30-day mortality were not significantly different between PN and RN, but overall mortality and 90-day mortality favored PN ( < 0.001). Cox regression for death showed PN with improved overall survival (HR 0.782, < 0.001). Logistic regression for predictors of cytoreductive PN revealed cT1 and cN0 as significant factors. Overall survival, as seen on KM analysis, identified that PN exhibited improved 2-year (67.1% vs. 52.0%) and 5-year (40.7% vs. 29.2%) overall survival relative to RN ( < 0.001).
PN is an infrequent treatment with mRCC and its utilization is stable from 2010 to 2017. Overall survival is significantly better for those undergoing PN, likely due to their favorable oncologic disease characteristics.
转移性肾细胞癌（mRCC）的减瘤性肾切除术是一种标准治疗方法。在转移性疾病背景下进行部分肾切除术（PN）的情况并不常见，我们旨在描述其在现代队列中的应用情况。
回顾2010年至2017年国家癌症数据库中mRCC患者的资料。收集接受以PN或根治性肾切除术（RN）形式进行减瘤手术的cTanyNanyM1患者。我们的主要结局是接受PN与RN的患者的生存结局。次要结局包括30天再入院率、住院时间和生存结局。
共确定13896例接受减瘤手术的mRCC患者。其中，13242例接受RN，654例接受PN。RN组更可能有cN阳性疾病，而PN组更可能有cT1疾病。PN组和RN组在住院时间、再入院率和30天死亡率方面无显著差异，但总体死亡率和90天死亡率PN组更优（<0.001）。死亡的Cox回归显示PN组总体生存率提高（HR 0.782，<0.001）。减瘤性PN预测因素的Logistic回归显示cT1和cN0是显著因素。从KM分析可见，总体生存率方面，PN组相对于RN组2年（67.1%对52.0%）和5年（40.7%对29.2%）总体生存率提高（<0.001）。
PN在mRCC中是一种不常用的治疗方法，其应用在2010年至2017年保持稳定。接受PN的患者总体生存率显著更好，可能是由于其有利的肿瘤疾病特征。
