部分肾切除术治疗未预料到的pT3a肾细胞癌的疗效

Dongsu Kim, B. Lim, J. Suh, D. You, Cheryn Song, I. Jeong, B. Hong, J. Hong, H. Ahn
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引用次数: 1

摘要

目的:比较病理性T3a (pT3a)肾癌(RCC)患者行部分肾切除术(PN)和根治性肾切除术(RN)的肿瘤预后。材料和方法:我们回顾性分析了2001年至2012年间接受PN和RN治疗的149例pT3a N0 M0 RCC患者。采用Kaplan-Meier法分析无复发生存期(RFS)和癌症特异性生存期(CSS),采用Cox比例风险回归模型确定预后因素。结果:在中位随访136个月(四分位数范围77-163个月)期间,共有41例复发(27.5%)和24例癌症相关死亡(16.1%)。我们观察到PN组和RN组的RFS和CSS无显著差异(RFS: 85.4±64.0个月vs. 75.9±52.8个月,p=0.061;CSS: 153.2±52.5个月vs. 124.9±59.8个月,p=0.292)。手术方式对肿瘤复发及患者生存无影响。在多变量Cox回归分析中,只有肿瘤大小与较差的RFS相关(风险比[HR], 1.237;95%置信区间[CI], 1.132-1.350;p<0.001)和CSS (HR, 1.156;95% ci, 1.027-1.302;p = 0.017)。结论:由于肿瘤体积较大,pT3a术后活检行PN时可能存在犹豫。我们的研究结果提示,由于肿瘤大小是唯一的预后因素,只要肾静脉没有血栓,pT3a患者可以行PN。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Efficacy of Partial Nephrectomy in the Management of Unpredicted pT3a Renal Cell Carcinoma
Purpose: To compare the oncological outcomes between patients with pathologic T3a (pT3a) renal cell carcinoma (RCC) who underwent partial nephrectomy (PN) and radical nephrectomy (RN).Materials and Methods: We retrospectively reviewed 149 patients with pT3a N0 M0 RCC who underwent PN and RN between 2001 and 2012. Recurrence-free survival (RFS) and cancer-specific survival (CSS) were analyzed using the Kaplan-Meier method and prognostic factors were identified using Cox proportional hazard regression models.Results: A total of 41 recurrences (27.5%) and 24 cancer related death (16.1%) were observed during a median follow-up of 136 months (interquartile range, 77–163 months). We observed no significant differences in the RFS and CSS between the PN and RN (RFS: 85.4±64.0 months vs. 75.9±52.8 months, p=0.061; CSS: 153.2±52.5 months vs. 124.9±59.8 months, p=0.292). The surgical method did not affect the tumor recurrence and patients’ survival. On multivariable Cox regression analysis, only tumor size remained associated with worse RFS (hazard ratio [HR], 1.237; 95% confidence interval [CI], 1.132–1.350; p<0.001) and CSS (HR, 1.156; 95% CI, 1.027–1.302; p=0.017).Conclusions: Due to the large tumor size, there may be hesitation in performing PN concerning pT3a in postoperative biopsy. Our study findings suggest that since tumor size is the only prognostic factor, PN can be performed in pT3a as long as there is no thrombus in the renal vein.
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