保留肾单位手术与根治性肾切除术治疗T_1期肾细胞癌对患者生存率及肾功能的影响比较
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摘要
目的比较保留肾单位手术(NSS)和根治性肾切除术(RN)治疗T1期肾细胞癌(RCC)对患者生存率及肾功能的影响。方法收集209例T1期RCC患者的临床资料,其中接受NSS治疗112例,接受RN治疗97例,对其进行了随访,比较接受NSS和RN治疗患者的总生存率和无进展生存率;通过估计肾小球滤过率(eGFR)变化和慢性肾脏疾病(CKD)发生情况判断患者术后肾功能变化。结果 RN治疗患者肿瘤大小大于NSS治疗患者,肿瘤分期高于NSS治疗患者,手术时间短于NSS治疗患者,住院天数多于NSS治疗患者,差异均有统计学意义(P﹤0.01)。NSS治疗患者的5年、10年累积生存率分别为95.7%和87.0%,分别高于RN治疗患者的83.7%、75.8%,差异均有统计学意义(P﹤0.05)。术后1天及术后3、6、12、24个月RN和NSS治疗患者e GFR水平均明显低于术前,且术后同时间RN治疗患者的eGFR水平均明显低于NSS治疗患者,术后1天及术后3、6、12、24个月NSS治疗患者CKD发生率均明显低于RN治疗患者,差异均有统计学意义(P﹤0.01)。结论对于T1期RCC患者,接受NSS治疗患者的总生存率及肾功能均优于接受RN治疗患者,在条件允许时,应优先选择NSS治疗RCC。
Objective To evaluated the survival rate and renal function of patients treated with nephron sparing surgery(NSS) or radical nephrectomy(RN) for T1 renal cell carcinoma(RCC). Method The clinical data of 209 patients with T1 RCC receiving NSS(n=112) or RN(n=97) were included and followed up. The overall survival rate and progression-free survival(PFS) rate in patients administered with NSS or RN were compared. Renal function outcomes were evaluated by estimated glomerular filtration rate(eGFR) and occurrence of chronic kidney disease(CKD). Result The patients treated with RN had larger tumor size, higher tumor stage, less operative time, and longer hospital stay than those in patients treated with NSS, with statistically significant differences observed(P<0.01). The 5-and 10-year cumulative survival rates in patients treated with NSS were 95.7% and 87.0%, which were significantly higher compared to that in patients treated with RN at 83.7% and 75.8%, respectively, indicating statistically significant differences(P<0.05). The level of eGFR in 1 d and 3, 6, 12, 24 months after surgery were markedly decreased in all patients, and that in patients treated with RN was significantly lower compared to patients treated with NSS, at the same time points after operation, the incidence of CKD in NSS-treated patients were evidently lower than that in those who were treated with RN, showing statistically significant difference(P<0.01). Conclusion In all, for patients with T1 RCC, the overall survival rate and renal function outcomes are all better when administered with NSS compared to RN, so NSS is preferred for renal cell carcinoma when applicable.
Objective To evaluated the survival rate and renal function of patients treated with nephron sparing surgery(NSS) or radical nephrectomy(RN) for T1 renal cell carcinoma(RCC). Method The clinical data of 209 patients with T1 RCC receiving NSS(n=112) or RN(n=97) were included and followed up. The overall survival rate and progression-free survival(PFS) rate in patients administered with NSS or RN were compared. Renal function outcomes were evaluated by estimated glomerular filtration rate(eGFR) and occurrence of chronic kidney disease(CKD). Result The patients treated with RN had larger tumor size, higher tumor stage, less operative time, and longer hospital stay than those in patients treated with NSS, with statistically significant differences observed(P<0.01). The 5-and 10-year cumulative survival rates in patients treated with NSS were 95.7% and 87.0%, which were significantly higher compared to that in patients treated with RN at 83.7% and 75.8%, respectively, indicating statistically significant differences(P<0.05). The level of eGFR in 1 d and 3, 6, 12, 24 months after surgery were markedly decreased in all patients, and that in patients treated with RN was significantly lower compared to patients treated with NSS, at the same time points after operation, the incidence of CKD in NSS-treated patients were evidently lower than that in those who were treated with RN, showing statistically significant difference(P<0.01). Conclusion In all, for patients with T1 RCC, the overall survival rate and renal function outcomes are all better when administered with NSS compared to RN, so NSS is preferred for renal cell carcinoma when applicable.
引文
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[18] Badalato GM, Kates M, Wisnivesky JP, et al. Survival after partial and radical nephrectomy for the treatment of stage T1bN0M0 renal cell carcinoma(RCC)in the USA:a propensity scoring approach[J]. BJU Int, 2012, 109(10):1457-1462.
[19] Larcher A, Capitanio U, Terrone C, et al. Elective nephron sparing surgery decreases other cause mortality relative to radical nephrectomy only in specific subgroups of patients withrenalcellcarcinoma[J].JUrol,2016,196(4):1008-1013.
[20] Kaushik D, Kim SP, Childs MA, et al. Overall survival and development of stage IV chronic kidney disease in patients undergoing partial and radical nephrectomy for benign renal tumors[J]. Eur Urol, 2013, 64(4):600-606.
[21] Weight CJ, Lieser G, Larson BT, et al. Partial nephrectomy is associated with improved overall survival compared to radical nephrectomy in patients with unanticipated benign renal tumours[J]. Eur Urol, 2010, 58(2):293-298.
[22] Iizuka J, Kondo T, Hashimoto Y, et al. Similar functional outcomes after partial nephrectomy for clinical T1b and T1a renal cell carcinoma[J]. Int J Urol, 2012, 19(11):980-986.
[23] Kim SP, Thompson RH, Boorjian SA, et al. Comparative effectiveness for survival and renal function of partial and radical nephrectomy for localized renal tumors:a systematic review and meta-analysis[J]. J Urol, 2012, 188(1):51-57.
[24] Capitanio U, Terrone C, Antonelli A, et al. Nephron-sparing techniques independently decrease the risk of cardiovascular events relative to radical nephrectomy in patients with a T1a-T1b renal mass and normal preoperative renal function[J]. Eur Urol, 2015, 67(4):683-689.
[25] Go AS, Chertow GM, Fan D, et al. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization[J]. N Engl J Med, 2004, 351(13):1296-1305.
[2] Novick AC. Partial nephrectomy for renal cell carcinoma[J]. Urology, 1995, 46(2):149-152.
[3] Herr HW. A history of partial nephrectomy for renal tumors[J]. J Urol, 2005, 173(3):705-708.
[4] Crépel M, Jeldres C, Sun M, et al. A population-based comparison of cancer-control rates between radical and partial nephrectomy for T1A renal cell carcinoma[J]. Urology,2010, 76(4):883-888.
[5] Daugherty M, Bratslavsky G. Compared with radical nephrectomy, nephron-sparing surgery offers a long-term survival advantage in patients between the ages of 20 and 44years with renal cell carcinomas(≤4 cm):an analysisof the SEER database[J]. Urol Oncol, 2014, 32(5):549-554.
[6] Smaldone MC, Egleston B, Uzzo RG, et al. Does partial nephrectomy result in a durable overall survival benefit in the medicarepopulation?[J]. J Urol, 2102, 188(6):2089-2094.
[7] Clavien PA, Barkun J, de Oliveira ML, et al. The ClavienDindo classification of surgical complications:five-year experience[J]. Ann Surg, 2009, 250(2):187-196.
[8] Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine[J]. Nephron, 1976, 16(1):31-41.
[9] Rini BI, Campbell SC, Escudier B. Renal cell carcinoma[J].Lancet, 2009, 373(9669):1119-1132.
[10] Sammon J, Petros F, Sukumar S, et al. Barbed suture for renorrhaphy during robot-assisted partial nephrectomy[J].J Endourol, 2011, 25(3):529-533.
[11] Patel SG, Penson DF, Pabla B, et al. National trends in the use of partial nephrectomy:a rising tide that has not lifted all boats[J]. J Urol, 2012, 187(3):816-821.
[12] Patard JJ, Shvarts O, Lam JS, et al. Safety and efficacy of partial nephrectomy for all T1 tumors based on an international multicenter experience[J]. J Urol, 2004, 171(6 Pt 1):2181-2185.
[13] Van Poppel H, Da Pozzo L, Albrecht W, et al. A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma[J]. Eur Urol, 2011, 59(4):543-552.
[14] Patard JJ, Pantuck AJ, Crepel M, et al. Morbidity and clinical outcome of nephron-sparing surgery in relation to tumour size and indication[J]. Eur Urol, 2007, 52(1):148-154.
[15] Thompson RH, Siddiqui S, Lohse CM, et al. Partial versus radical nephrectomy for 4 to 7 cm renal cortical tumors[J].J Urol, 2009, 182(6):2601-2606.
[16] Campbell SC, Novick AC. Expanding the indications for elective partial nephrectomy:is this advisable?[J]. Eur Urol, 2006, 49(6):952-954.
[17] Leibovich BC, Blute M, Cheville JC, et al. Nephron sparing surgery for appropriately selected renal cell carcinoma between 4 and 7 cm results in outcome similar to radical nephrectomy[J]. J Urol, 2004, 171(3):1066-1070.
[18] Badalato GM, Kates M, Wisnivesky JP, et al. Survival after partial and radical nephrectomy for the treatment of stage T1bN0M0 renal cell carcinoma(RCC)in the USA:a propensity scoring approach[J]. BJU Int, 2012, 109(10):1457-1462.
[19] Larcher A, Capitanio U, Terrone C, et al. Elective nephron sparing surgery decreases other cause mortality relative to radical nephrectomy only in specific subgroups of patients withrenalcellcarcinoma[J].JUrol,2016,196(4):1008-1013.
[20] Kaushik D, Kim SP, Childs MA, et al. Overall survival and development of stage IV chronic kidney disease in patients undergoing partial and radical nephrectomy for benign renal tumors[J]. Eur Urol, 2013, 64(4):600-606.
[21] Weight CJ, Lieser G, Larson BT, et al. Partial nephrectomy is associated with improved overall survival compared to radical nephrectomy in patients with unanticipated benign renal tumours[J]. Eur Urol, 2010, 58(2):293-298.
[22] Iizuka J, Kondo T, Hashimoto Y, et al. Similar functional outcomes after partial nephrectomy for clinical T1b and T1a renal cell carcinoma[J]. Int J Urol, 2012, 19(11):980-986.
[23] Kim SP, Thompson RH, Boorjian SA, et al. Comparative effectiveness for survival and renal function of partial and radical nephrectomy for localized renal tumors:a systematic review and meta-analysis[J]. J Urol, 2012, 188(1):51-57.
[24] Capitanio U, Terrone C, Antonelli A, et al. Nephron-sparing techniques independently decrease the risk of cardiovascular events relative to radical nephrectomy in patients with a T1a-T1b renal mass and normal preoperative renal function[J]. Eur Urol, 2015, 67(4):683-689.
[25] Go AS, Chertow GM, Fan D, et al. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization[J]. N Engl J Med, 2004, 351(13):1296-1305.