PN与RN治疗T1b和T2a期肾细胞癌疗效及安全性比较的分析

Comparison of efficacy and safety of PN and RN in the treatment of stage T1b and T2a renal cell carcinoma

目的比较肾部分切除术(PN)与根治性肾切除术(RN)治疗临床T1b和T2a期肾癌的疗效、手术安全性及生存情况。方法回顾性分析2014年4月-2017年7月于南昌大学第一附属医院泌尿外科收治的115例T1b和T2a期肾癌患者,根据手术方式不同分为PN组(n=55)和RN组(n=60),比较两组的临床资料及预后。结果PN组和RN组在一般临床资料与围手术期相关因素方面,差异无统计学意义(P>0.05)。PN组手术并发症明显高于RN组,差异有统计学意义(P=0.024),而在术后严重并发症(Clavien分级≥3级)发生率方面差异无统计学意义(P>0.05)。两组术前血肌酐差异无统计学意义(P>0.05),而PN组术后第1天,第3、6、12个月血肌酐明显低于RN组(P<0.05)。术后随访5年以上,PN组和RN组在5年生存率、总生存率、复发转移率和肿瘤特异性生存率等方面差异均无统计学意义(P>0.05)。结论PN与RN治疗T1b和T2a期肾癌总体安全有效,两种术式都能达到良好的肿瘤学控制效果。相较于RN,PN更能充分有效地保护患者术后肾功能,但同时伴随着更高的手术并发症发生率,而在术后严重并发症(Clavien分级≥3级)的发生率方面差异不明显。

Objective To compare the efficacy,safety and survival of partial nephrectomy(PN)and radical nephrectomy(RN)in the treatment of clinical T1b and T2a renal cell carcinoma(RCC).Methods A total of 115 patients with stage T1b and T2a RCC treated during Apr.2014 and Jul.2017 were retrospectively analyzed.According to the different surgical methods,the patients were divided into PN group(n=55)and RN group(n=60).The clinical data and prognosis of the two groups were compared.Results There were no significant differences in the general clinical data and perioperative related factors between the two groups(P>0.05).The incidence of complications was significantly higher in PN group than in RN group(P=0.024),but there was no significant difference in serious complications(Clavien grade≥3)(P>0.05).In terms of renal function recovery,there was no significant difference in serum creatinine between the two groups before operation(P>0.05),but the serum creatinine was significantly lower in PN group than in RN group on the 1st day,3rd,6th and 12th months after operation(P<0.05).After more than 5 years of follow-up,there was no significant difference in 5-year survival rate,overall survival rate,recurrence and metastasis rate,and cancer specific survival rate between the two groups(P>0.05).Conclusion Both PN and RN are safe and effective in the treatment of stage T1b and T2a RCC,and can achieve good oncological control effects.Compared with RN,PN can fully and effectively protect the postoperative renal function,but it causes more surgical complications.However,there is no significant difference in severe complications(Clavien grade≥3).