手术治疗肾癌根治术后孤立局部复发病灶的长期预后分析

Long-term outcome of isolated local recurrence following radical nephrectomy

目的:分析手术切除肾癌根治术后局部复发病灶的长期疗效以及肾癌局部复发病灶的长期预后因素。方法:回顾性研究北京大学第一医院泌尿外科局限性肾癌接受根治术后出现局部孤立复发病灶患者资料。根据现有文献资料,局部复发定义为肾窝、同侧肾上腺以及同侧腹膜后淋巴结出现的复发病灶。本研究中位随访时间为62个月,肿瘤特异性生存时间与肿瘤复发模式的评估使用Kaplan-Meier方法进行。结果:从1994年1月至2011年12月共有1 045名患者因肾癌于北京大学第一医院接受了肾癌根治术,其中有15名患者在随访时间(62.7±36.2)个月中出现了局部复发,有9名患者接受了手术治疗,余6名患者未接受手术治疗。接受手术治疗的患者1年肿瘤特异性生存率为87%,未接受手术治疗患者为60%;4年肿瘤特异性生存率在接受手术治疗的患者中为72%,在未接受手术治疗的患者中仅为30%。手术治疗组和未接受手术患者的生存时间分别为(51.8±7.4)个月和(28.4±9.2)个月,复发间隔时间分别为(39.4±29.5)个月和(29.3±23.9)个月。结论:有选择地对肾癌局部复发病灶进行手术切除是一种可行的治疗手段,并可能延长患者生存时间。

Objective：To characterize the long-term outcome of surgical extirpation for local recurrence after radical nephrectomy of renal cell carcinoma （RCC） and identify prognostic factors for locally recur- rent RCC. Methods： Peking University First Hospital urologic database was queried for all patients with isolated local recurrence following radical nephrectomy for localized RCC. According to previous litera- ture, local recurrence included relapse in the renal fossa, ipsilateral adrenal gland and ipsilateral retro- peritoneal lymph nodes. The median follow up was 62 months. The cancer specific survival and relapse patterns were estimated using the Kaplan-Meier method. Results： In our institutional database, 1 045 pa- tients were treated with nephrectomy for localized RCC from January 1994 to December 2011. With a post- operative follow-up of （62.7 ±36.2） months, 15 patients （ 1.44% ） experienced local recurrence, 9 of which were managed by surgical resection, and the rest 6 did not receive operation. The patients who re- ceived surgical resection had a 1-year cancer specific survival rate of 87% , compared with 60% of the patients without receiving surgical treatment. The 4-year cancer specific survival rate was 72% vs. 30%. The survival time was （ 51.8 ± 7.4 ） months vs. （ 28.4 ± 9.2 ） months. The recurrence interval was （ 39.4 ± 29.5 ） months vs. （ 29.3 ± 23.9 ） months. Conclusion： Surgical resection for local recurrence of RCC in selected oatients is a feasible management and may orolon~ the survival time.