部分肾切除术与根治性肾切除术对较大肾细胞癌预后的对比研究
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摘要
目的:比较部分肾切除术与根治性肾切除术对较大肾细胞癌(>4cm)患者预后的影响。方法:选取2010年1月～2013年12月于我院就诊并行手术治疗的肾细胞癌患者为研究对象,肿瘤临床分期为T_(1b)N_0M_0或T_2N_0M_0期,按照手术方式分为部分肾切除术组与根治性肾切除术组,病例数1∶1,全部为开放性手术,比较患者术后截至2017年12月的总生存率(OS)、术后1个月内再入院率及术后1、3个月手术相关死亡率。结果:共计118例患者纳入研究,多变量分析显示部分肾切除术组患者中T_(1b)期与较好的总生存预后相关(HR=0.82,95%CI:0.72～0.88,P<0.001);T_2期中部分肾切除术组对患者的生存有利,但差异无统计学意义(HR=0.84,95%CI:0.70～1.11,P=0.313);部分肾切除术组患者术后1个月内因出血、尿漏等再入院率显著高于根治性肾切除术组(5.1%vs.3.4%,P<0.05),但两组术后1、3个月相关死亡率比较差异无统计学意义(P>0.05)。结论:对于较大的肾细胞癌,T_(1b)期患者行部分肾切除术较根治性肾切除术更有利于患者的生存预后,但T_2期患者2种手术方式对生存预后无显著性差异,≥T_(1b)期患者部分切除术后1个月内再入院率较根治性手术者显著升高。
Objective:To investigate the effect of partial and radical nephrectomy on the prognosis of patients with large renal cell carcinoma(>4 cm).Method:The patients with renal cell carcinoma who were admitted to our hospital from January 2010 to December 2013 were selected as study subjects.The clinical stage of the tumor was T_(1b)N_0 M_0 or T_2 N_0 M_0.The patients were divided into two groups according to the operation methods.The rate of cases was 1∶1 and all surgeries were traditional open surgeries.The total postoperative survival rate of patients(until December 2017),re-admission rate within 30 days,postoperative 1 month and 3 months related mortality between groups were compared.Result:A total of 118 patients were included.Multivariate analysis showed that those with T_1 bstage tumor who underwent partial nephrectomy were associated with better overall survival(HR=0.82,95%CI:0.72-0.88,P<0.001);in the T_2 stage tumor partial resection was beneficial to patients' survival,but no significant difference(HR=0.84,95%CI:0.70-1.11,P=0.313).The chance of rehospitalization within 30 days(mainly hemorrhage,urine leakage)after partial nephrectomy was significantly higher than that of radical resection group(5.1% vs.3.4%,P<0.05).However,there was no significant difference between the two groups in the incidence of related death events at 1 month and 3 months(P>0.05).Conclusion:In the case of large renal cell carcinoma,partial nephrectomy performed on T_1 bpatients is more beneficial to the prognosis than radical surgery.However,there is no significant difference of animation prognosis between the two groups in T_2 stage tumor.The probability of hospital readmission within 30 days of patients with renal cell carcinoma≥T_1 bafter radical surgery is lower compared with those after partial nephrectomy.
Objective:To investigate the effect of partial and radical nephrectomy on the prognosis of patients with large renal cell carcinoma(>4 cm).Method:The patients with renal cell carcinoma who were admitted to our hospital from January 2010 to December 2013 were selected as study subjects.The clinical stage of the tumor was T_(1b)N_0 M_0 or T_2 N_0 M_0.The patients were divided into two groups according to the operation methods.The rate of cases was 1∶1 and all surgeries were traditional open surgeries.The total postoperative survival rate of patients(until December 2017),re-admission rate within 30 days,postoperative 1 month and 3 months related mortality between groups were compared.Result:A total of 118 patients were included.Multivariate analysis showed that those with T_1 bstage tumor who underwent partial nephrectomy were associated with better overall survival(HR=0.82,95%CI:0.72-0.88,P<0.001);in the T_2 stage tumor partial resection was beneficial to patients' survival,but no significant difference(HR=0.84,95%CI:0.70-1.11,P=0.313).The chance of rehospitalization within 30 days(mainly hemorrhage,urine leakage)after partial nephrectomy was significantly higher than that of radical resection group(5.1% vs.3.4%,P<0.05).However,there was no significant difference between the two groups in the incidence of related death events at 1 month and 3 months(P>0.05).Conclusion:In the case of large renal cell carcinoma,partial nephrectomy performed on T_1 bpatients is more beneficial to the prognosis than radical surgery.However,there is no significant difference of animation prognosis between the two groups in T_2 stage tumor.The probability of hospital readmission within 30 days of patients with renal cell carcinoma≥T_1 bafter radical surgery is lower compared with those after partial nephrectomy.
引文
1李成文,高加胜,叶韬,等.腹腔镜与开放性肾部分切除术治疗T1a期肾肿瘤的疗效比较[J].临床泌尿外科杂志,2018,33(12):972-975.
2 Lee H J,Liss M A,Derweesh I H.Outcomes of partial nephrectomy forclinical T1band T2renal tumors[J].Curr Opin Urol,2014,24(5):448-452.
3王徽,于德新,谢栋栋,等.保留肾单位手术治疗T1b期肾细胞癌[J].临床泌尿外科杂志,2015,30(6):481-484.
4 Jang H A,Yong H P,Hong S H,et al.1642oncologic and functionaloutcomes after partial nephrectomy versus radical nephrectomy in T1brenal cell carcinoma:a multicenter,matched case-control study in Koreanpatients[J].J Urol,2013,189(4):612-620.
5贾卓,巩艳青,张崔建,等.3~4期慢性肾脏病对肾癌术后患者的预后影响分析[J].临床泌尿外科杂志,2018,33(10):806-811.
6 Thompson R H,Siddiqui S,Lohse C M,et al.Partial versus radicalnephrectomy for 4to 7cm renal cortical tumors[J].J Urol,2009,182(6):2601-2606.
7王勇,温元毅.肾细胞癌患者行保留肾单位手术与根治性手术的效果及生活质量比较[J].解放军医药杂志,2017,29(9):59-62.
8 Alanee S,Nutt M,Moore A,et al.Mp70-08partial nephrectomy for T2renal masses:national trends and oncologic efficacy[J].Int Urol Nephrol,2015,47(6):945-950.
9 Hansen J,Sun M,Bianchi M,et al.Assessment of cancer control outcomes in patients with high-risk renal cell carcinoma treated withpartial nephrectomy[J].Urology,2012,80(2):347-353.
10 Badalato G M,Kates M,Wisnivesky J P,et al.Survival after partialand radical nephrectomy for the treatment of stage T1b N0M0 renal cellcarcinoma(RCC)in the USA:apropensity scoring approach[J].BJU Int,2012,109(10):1457-1462.
11李晓红.腹腔镜保留肾单位肾肿瘤切除术与根治性肾切除术对肾细胞癌患者术后肾功能及生存质量影响分析[J].临床误诊误治,2017,30(2):95-98.
12 Kopp R P,Mehrazin R,Palazzi K L,et al.Survival outcomes afterradical and partial nephrectomy for clinical T2renal tumours categorised by R.E.N.A.L.nephrometry score[J].BJU Int,2014,114(5):708-718.
13吴肖冰,张古田,张帆,等.肾部分切除术治疗孤立肾肾癌的安全性和疗效分析[J].中华外科杂志,2016,54(10):746-750.
2 Lee H J,Liss M A,Derweesh I H.Outcomes of partial nephrectomy forclinical T1band T2renal tumors[J].Curr Opin Urol,2014,24(5):448-452.
3王徽,于德新,谢栋栋,等.保留肾单位手术治疗T1b期肾细胞癌[J].临床泌尿外科杂志,2015,30(6):481-484.
4 Jang H A,Yong H P,Hong S H,et al.1642oncologic and functionaloutcomes after partial nephrectomy versus radical nephrectomy in T1brenal cell carcinoma:a multicenter,matched case-control study in Koreanpatients[J].J Urol,2013,189(4):612-620.
5贾卓,巩艳青,张崔建,等.3~4期慢性肾脏病对肾癌术后患者的预后影响分析[J].临床泌尿外科杂志,2018,33(10):806-811.
6 Thompson R H,Siddiqui S,Lohse C M,et al.Partial versus radicalnephrectomy for 4to 7cm renal cortical tumors[J].J Urol,2009,182(6):2601-2606.
7王勇,温元毅.肾细胞癌患者行保留肾单位手术与根治性手术的效果及生活质量比较[J].解放军医药杂志,2017,29(9):59-62.
8 Alanee S,Nutt M,Moore A,et al.Mp70-08partial nephrectomy for T2renal masses:national trends and oncologic efficacy[J].Int Urol Nephrol,2015,47(6):945-950.
9 Hansen J,Sun M,Bianchi M,et al.Assessment of cancer control outcomes in patients with high-risk renal cell carcinoma treated withpartial nephrectomy[J].Urology,2012,80(2):347-353.
10 Badalato G M,Kates M,Wisnivesky J P,et al.Survival after partialand radical nephrectomy for the treatment of stage T1b N0M0 renal cellcarcinoma(RCC)in the USA:apropensity scoring approach[J].BJU Int,2012,109(10):1457-1462.
11李晓红.腹腔镜保留肾单位肾肿瘤切除术与根治性肾切除术对肾细胞癌患者术后肾功能及生存质量影响分析[J].临床误诊误治,2017,30(2):95-98.
12 Kopp R P,Mehrazin R,Palazzi K L,et al.Survival outcomes afterradical and partial nephrectomy for clinical T2renal tumours categorised by R.E.N.A.L.nephrometry score[J].BJU Int,2014,114(5):708-718.
13吴肖冰,张古田,张帆,等.肾部分切除术治疗孤立肾肾癌的安全性和疗效分析[J].中华外科杂志,2016,54(10):746-750.