T1b期肾癌患者肾部分切除和肾癌根治术预后比较的Meta分析

Comparison of partial nephrectomy and radical nephrectomy for T1brenal cell carcinoma:ameta-analysis

目的比较T1b期肾癌患者行肾部分切除术（PN）和肾癌根治术（RN）的疗效和预后差异,为临床选择手术方式提供循证依据。方法检索Medline、EMBASE、Cochrane library、CNKI中文期刊全文数据库,以Radical nephrectomy（肾癌根治术）,Partial nephrectomy（肾部分切除术）、Renal cell carcinoma（肾细胞癌）、T1bN0M0为检索词,收集国内外公开发表的关于肾癌患者肾部分切除和肾癌根治术的临床对照研究。结果共纳入文献8篇,涉及61 826例患者。比较两种手术方式术后的复发、转移、5年死亡率、5年肿瘤特异性生存率的比值比（OR）分别为5.44（95%CI 1.34-22.06）、0.39（95%CI 0.18-0.83）、0.87（95%CI0.32-2.36）、0.52（95%CI0.05-5.88）,术后血肌酐和肾小球滤过率（GFR）均值差（MD）分别为-11.63（95%CI-24.58-1.32）、6.75（95%CI-0.55-14.06）,2种手术方式在术后死亡率、术后肿瘤特异性死亡率、术后GFR和术后血肌酐的差异无统计学意义。PN术后肿瘤复发的发生率高于RN。PN术后肿瘤远处转移的发生率少于RN。结论两种手术方式,在术后患者的5年总体死亡率、5年肿瘤特异性生存率、术后血肌酐和GFR均无差异。而术后的肿瘤的复发,RN组优于PN组,然而远处转移侧相反。但是由于肾部分切除术最大限度地保留了残余肾单位,在保证肿瘤治疗效果的同时,尽可能地保留了患肾功能,因此对T1b期肾癌,PN是一种安全可靠的治疗方式。

Objective To evaluate the efficacy and prognosis of partial nephrectomy（PN）and radical nephrectomy（RN）in the treatment of T1 b renal cell carcinoma.Methods Relevant studies about surgical treatment of T1 b renal cell carcinoma included in databases including Medline,Cochrane library and CNKI were retrieved with key words＂radical nephrectomy＂,＂partial nephrectomy＂,＂renal cell carcinoma＂,and＂T1bN0M0＂.Results A total of 8 trials were collected,and61 826 patients were involved.We analyzed the tumor recurrence（OR=5.44,95%CI：1.34-22.06）,tumor metastasis（OR=0.39,95%CI：0.18-0.83）,5-year overall survival（OS）（OR=0.87,95%CI：0.32-2.36）,5-year cancer specific survival（CSS）（OR=0.52,95%CI：0.05-5.88）,Scr（MD=-11.63,95%CI：-24.58-1.32）,and GFR（MD=6.75,95%CI：-0.55-14.06）after PN and RN.There was no significant difference in 5-year OS,5-year CSS,Scr and GFR between RN and RN.RN was superior to PN in tumor recurrence,but PN was superior in tumor metastasis.Conclusions There is no significant difference between PN and RN in5-year OS,5-year CSS and renal function.RN is superior to PN in local recurrence.However,in distant metastasis,PN is better.PN could maximally preserve the remaining renal function and improve the quality of life in late stage.Therefore,PN is an effective and reliable treatment for T1 b renal cell carcinoma.