Ren Kong, Wu Fei, Wu Haihu, Ning Hao, Lyu Jiaju
Department of Urology, The Second School of Clinical Medicine of Binzhou Medical University, Yantai, China.
Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.
Curr Urol. 2024 Dec;18(4):328-335. doi: 10.1097/CU9.0000000000000229. Epub 2023 Nov 3.
This study compared the long-term efficacy and prognostic factors of partial nephrectomy (PN) and radical nephrectomy (RN) for T1bN0M0 renal cell carcinoma (RCC) using data from the Surveillance, Epidemiology, and End Results database.
We retrospectively analyzed the clinical data of 12,471 patients diagnosed with T1bN0M0 RCC from the Surveillance, Epidemiology, and End Results database between 2010 and 2019. Patients were divided into the PN and RN groups, and propensity score matching was conducted to balance the differences between the groups. We compared overall survival (OS), RCC cancer-specific mortality (CSM), and noncancer-specific mortality (NCSM) between the 2 groups. The risk factors for all-cause and RCC-related mortality were analyzed.
After propensity score matching, there were 3817 patients in each group. After matching, OS and NCSM were significantly longer in the PN group ( < 0.001); however, there was no significant between-group difference in the RCC-CSM. The hazard ratio (HR) for all-cause mortality was significantly lower in the PN group (HR, 0.671; 95% confidence interval [CI], 0.579-0.778, < 0.001), but PN was not associated with lower RCC-related mortality. Subgroup analysis showed that PN reduced the HR of all-cause mortality by 35% (HR, 0.647; 95% CI, 0.536-0.781; < 0.001) in patients with 4.0- to 5.5-cm tumors compared with RN and by 29% (HR, 0.709; 95% CI, 0.559-0.899; = 0.004) in those with larger tumors (5.6-7.0 cm). Multifactorial analysis showed that PN was an independent predictor of OS (HR, 0.671; 95% CI, 0.579-0.778; < 0.001). In addition, multivariate analysis validated that age at diagnosis, sex, pathological grade, and tumor size were associated with outcomes.
In patients with T1b RCC, PN resulted in better OS and NCSM outcomes than RN. The benefit of PN in all-cause mortality was pronounced in patients with 4.0-5.5 cm tumor loads. Therefore, individualized treatment schemes should prioritize PN, when technically feasible.
本研究利用监测、流行病学和最终结果数据库的数据，比较了部分肾切除术（PN）和根治性肾切除术（RN）治疗T1bN0M0肾细胞癌（RCC）的长期疗效和预后因素。
我们回顾性分析了2010年至2019年间从监测、流行病学和最终结果数据库中诊断为T1bN0M0 RCC的12471例患者的临床资料。将患者分为PN组和RN组，并进行倾向评分匹配以平衡两组之间的差异。我们比较了两组之间的总生存期（OS）、RCC癌症特异性死亡率（CSM）和非癌症特异性死亡率（NCSM）。分析了全因死亡率和RCC相关死亡率的危险因素。
倾向评分匹配后，每组有3817例患者。匹配后，PN组的OS和NCSM明显更长（<0.001）；然而，RCC-CSM在组间没有显著差异。PN组全因死亡率的风险比（HR）显著更低（HR，0.671；95%置信区间[CI]，0.579-0.778，<0.001），但PN与较低的RCC相关死亡率无关。亚组分析显示，与RN相比，PN使肿瘤大小为4.0至5.5 cm的患者全因死亡率的HR降低了35%（HR，0.647；95%CI，0.536-0.781；<0.001），使肿瘤较大（5.6-7.0 cm）的患者全因死亡率的HR降低了29%（HR，0.709；95%CI，0.559-0.899；=0.004）。多因素分析显示，PN是OS的独立预测因素（HR，0.671；95%CI，0.579-0.778；<0.001）。此外，多变量分析证实诊断时的年龄、性别、病理分级和肿瘤大小与预后相关。
在T1b期RCC患者中，PN的OS和NCSM结局优于RN。PN在全因死亡率方面的益处对于肿瘤负荷为4.0-5.5 cm的患者尤为明显。因此，在技术可行的情况下，个体化治疗方案应优先选择PN。
