- 作者：Pierre Bigot ; Jean-Fran莽ois H茅tet ; Jean-Christophe Bernhard ; Tarek Fardoun ; Fran莽ois Audenet ; Evanguelos Xylinas ; Guillaume Ploussard ; G茅raldine Pignot ; Thomas Bessede ; Idir Ouzaid ; Edouard Robine ; Laurent Brureau ; Olivier Merigot de Treigny ; Charlotte Maurin ; Jean-Alex ; re Long ; Jean Rouffilange ; Nicolas Hoarau ; Souhil Lebdai ; Morgan Roupr锚t ; Laurence Bastien ; Yann Neuzillet ; et al.
- 关键词：Complications ; Functional outcome ; Nephron sparing surgery ; Oncologic outcome ; Renal cell carcinoma ; Surgical treatment
- 刊名：Clinical Genitourinary Cancer
- 出版年：February, 2014
- 年：2014
- 卷：12
- 期：1
- 页码：e19-e27
- 全文大小：528 K
Background
The purpose of this study was to evaluate morbidity, functional, and oncological outcomes after NSS in聽renal tumors > 7 cm.Materials and Methods
We retrospectively analyzed data from 168 patients with tumors >聽7聽cm who were treated using NSS between 1998 and聽2012.
Results
Imperative and elective indications accounted for 76 (45.2%) and 92 (54.8%) patients, respectively. Major perioperative complications and renal function deterioration occurred in 33 (19.6%) and 51 patients (30.4%), respectively. In multivariate analysis, age older than 60 years (P聽= .001; hazard ratio [HR], 5) and tumor malignancy (P聽= .014; HR, 6.7) were prognostic factors for renal function deterioration whereas imperative indication was a risk factor for major postoperative complications (P聽= .0019; HR, 2.7). In 126 (75%) patients with malignant tumors, after a median follow-up of 30 months (range, 1-254 months), 25聽patients (20.2%) died. In multivariate analysis, imperative indication (P聽= .023; HR, 4.2), positive surgical margin (P聽= .021; HR, 3.3), and Fuhrman grade > II (P聽= .013; HR, 3.7) were prognostic indicators for cancer-free survival (CFS). Imperative indication (P聽= .04; HR, 8.5) and Fuhrman grade > II (P聽= .04; HR, 3.9) were predictive factors of cancer-specific survival (CSS). In case of elective indication, positive surgical margin, local recurrence, and cancer-related death occurred in 4 (7.6%), 1 (1.1%), and 1 (1.1%) cases, respectively. For elective indication, 5-year estimates of CFS, CSS, and overall survival rates were: 85.7%, 98%, and 93.9%, respectively.
Conclusion
In this selected population, imperative vs. elective indication status seems to play a critical role in oncologic outcomes. Oncologic results for elective indications are close to those reported with radical nephrectomy.