Lerner S E, Hawkins C A, Blute M L, Grabner A, Wollan P C, Eickholt J T, Zincke H
Department of Urology, Mayo Clinic, Rochester, Minnesota 55905, USA.
J Urol. 1996 Jun;155(6):1868-73.
We investigated the outcome of nephron sparing surgery in patients with low grade and low stage (Robson stage II or less) renal cell carcinoma.
We retrospectively reviewed the records of 185 patients treated with nephron sparing surgery and 209 matched for patient age and sex, and tumor stage and grade who were treated with radical nephrectomy. Kaplan-Meier survival curves were constructed for progression and survival end points. Multivariate analysis was performed to determine the tumor characteristics independently correlated with progression and cancer death.
No significant difference was observed with respect to progression-free, crude or cancer specific survival between the nephron sparing surgery and radical nephrectomy groups. Less than 5% of the patients treated with conservative nephron sparing surgery had local recurrence. Tumor size was a strong independent predictor of outcome, whereas Robson stage was not. Patients treated with radical nephrectomy had a significant cancer specific and progression-free survival advantage when controlling for tumor diameter and grade. However, no difference was observed in patients with primary tumor diameters of 4 cm. or less.
Robson staging is inaccurate in predicting tumor behavior. Patients with tumors larger than 4 cm. and a normal contralateral kidney may be best served by radical nephrectomy rather than elective nephron sparing surgery. However, nephron sparing surgery may result in an outcome similar to that of radical nephrectomy for low grade, low stage renal cell carcinomas of 4 cm. or smaller.
我们研究了低级别、低分期（罗布森分期II期或更低）肾细胞癌患者行保留肾单位手术的结果。
我们回顾性分析了185例行保留肾单位手术患者的记录，并与209例年龄、性别、肿瘤分期和分级相匹配的行根治性肾切除术患者的记录进行对比。构建了无进展生存期和总生存期的Kaplan-Meier生存曲线。进行多因素分析以确定与疾病进展和癌症死亡独立相关的肿瘤特征。
保留肾单位手术组与根治性肾切除术组在无进展生存期、总生存期或癌症特异性生存期方面未观察到显著差异。接受保守性保留肾单位手术的患者中，局部复发率不到5%。肿瘤大小是预后的一个强有力的独立预测因素，而罗布森分期则不是。在控制肿瘤直径和分级后，行根治性肾切除术的患者具有显著的癌症特异性和无进展生存期优势。然而，对于原发肿瘤直径4 cm及以下的患者，未观察到差异。
罗布森分期在预测肿瘤行为方面不准确。对于肿瘤大于4 cm且对侧肾脏正常的患者，根治性肾切除术可能比选择性保留肾单位手术更合适。然而，对于直径4 cm及以下的低级别、低分期肾细胞癌，保留肾单位手术可能会产生与根治性肾切除术相似的结果。
