保留肾单位手术和肾癌根治手术治疗局限性肾癌疗效比较的Meta分析

Comparison of Nephron-sparing Surgery vs.Radical Nephrectomy in Patients with Localized Renal Cell Carcinoma:A Meta-analysis

目的:总结局限性肾癌患者进行保留肾单位手术(NSS)和肾癌根治术(RN)后的疗效差异,为临床上提供循证依据。方法:收集Medline、EMbase和CNKI中国期刊全文数据库、维普数据库、万方数字化期刊群2010年8月30日前国内外公开发表的有关局限性肾癌患者行NSS与RN疗效和安全性比较的临床对照研究文献,对符合要求的文献进行Meta法系统分析。结果:按照标准纳入的NSS与RN比较的研究共有14项,共20 748例。2种手术方式术后5年死亡率、肿瘤复发率、肿瘤转移率和术后并发症总发生率的相对危险度(RR)分别为1.02(95%CI 0.57～1.81)、0.58(95%CI 0.31～1.07)、0.44(95%CI 0.1 6～1.21)、1.62(95%CI 1.32～1.98),其中术后并发症出血、尿漏、肾衰竭的RR分别为2.2(95%CI 1.58～3.06)、14.07(95%CI 2.60～76.13)、0.25(95%CI 0.20～0.31),2种手术方式术后5年死亡率和肿瘤复发率、转移率的差异无统计学意义,术后肾衰竭并发症方面NSS优于RN,而术后的并发症总发生率、出血、尿漏并发症RN优于NSS。结论:2种手术术后5年死亡率和控制术后肿瘤复发、转移方面没有明显差别,但NSS可以最大限度地保存残肾的肾单位和残肾功能,避免发生术后肾衰竭,而RN在预防术后并发症方面稍优于NSS。所以局限性肾癌患者,选择NSS是一种有效和可靠的治疗方法。

Objective：To assess the efficacy and safety of nephron-sparing surgery （NSS） and radical nephrectomy （RN） for localized renal cell carcinoma. Methods： We searched MEDLINE, EMbase, CNKI, VIP and WANGFANG from January 1979 to August 2010 for clinical controlled trials that evaluated the efficacy and safety of NSS and RN for localized renal cell carcinoma. After assessed the quality of included studies and extracted data, we analyzed the data using Review Manager （version 4.2）. The following factors were examined： tumor mortality, recurrence, metastasis and complications （bleeding, urine leak and kidney function failure）. Results：Fourteen trials involving 20748 patients were identified. The results of meta analysis were as follows： there were no signifi- cant differences between NSS and RN in five year eancer-rel.ated mortality （Relative risk, RR= 1.02, 95% CI：0. 57-1.81）, tumor recurrence （RR=0.58, 95% CI：0. 31-1.07） and tumor metastasis （RR= 0.44, 95%CI：0.16- 1.21）. There were significant differences between NSS and RN in the overall incidence of complications （RR= 1. 62, 95% CI：I. 32-1.98）, bleeding （RR=2.2, 95% CI：I. 58-3.06）, urine leak （RR= 14.07, 95%CI：2.60-76. la） and kidney function failure （RR=0. 25, 950//00 CI：0. 20-0.31）. RN was superior to prevent the overall incidence of complications, bleeding and urine leak（P≤0.05）. However, NSS was superior to prevent the kidney function failure（P≤0.05）. Conclusions： There is no significant differences between NSS and RN with regard to five year cancer-related mortality, tumor recurrence and metastasis. Though RN is superior to prevent the postoperative complications, NSS could maximally preserve the function of remaining nephron and reduce the risk for kidney function failure. NSS is an effective and reliable treatment for localized renal cell carcinoma.