肾部分切除术治疗局限性肾癌患者远期生存结果:单中心20年2046例总结

Efficacy of partial nephrectomy in patients with localized renal carcinoma:a 20-year experience of 2046 patients in a single center

目的探讨局限性肾癌患者肾部分切除术后远期生存情况。方法回顾性分析2001年8月至2021年2月在中山大学肿瘤防治中心接受肾部分切除术的2046例局限性肾癌患者的临床和病理学资料。男性1402例,女性644例,诊断年龄[M(IQR)]51(19)岁(范围:6~86岁)。以肿瘤特异性生存为主要研究终点,采用Kaplan-Meier法绘制生存曲线,使用Log-rank检验比较差异。采用单因素和多因素Cox比例风险模型分析与肿瘤特异性生存相关的因素。结果随访时间为49.2(48.0)个月(范围:1~229个月),生存1974例,死亡72例。中位肿瘤特异性生存期未达到。5年和10年肿瘤特异性生存率分别为97.0%和91.2%。pT1a(1447例)、pT1b(523例)、pT2期(58例)患者的10年肿瘤特异性生存率分别为95.3%、81.8%、81.7%。病理核分级G1(226例)、G2(1244例)、G3~4级(278例)患者的10年肿瘤特异性生存率分别为96.6%、89.4%、85.5%。开放、腹腔镜和机器人手术患者的5年肿瘤特异性生存率无差异(96.7%比97.1%比97.5%,P=0.600)。多因素分析结果显示,年龄≥50岁(HR=3.93,95%CI:1.82~8.47,P<0.01)、T分期(T1b期比T1a期:HR=3.31,95%CI:1.83~5.99,P<0.01;T2~3期比T1a期:HR=2.88,95%CI:1.00~8.28,P=0.049)、病理核分级(G3~4级比G1级:HR=2.81,95%CI:1.01~7.82,P=0.048)是肾部分切除术后肾癌患者的独立预后因素。结论局限性肾癌患者行肾部分切除术后远期肿瘤特异性生存率高。手术方式(开放、腹腔镜或机器人)对患者生存无明显影响,但年龄越大、病理核分级越高、T分期越高的患者,远期肿瘤特异性生存率越低。严格把握手术适应证,重视术前评估、围手术期管理和术后随访,有助于取得良好的远期生存。

Objectives To analyze the long-term survival of patients with localized renal cell carcinoma after partical nephrectomy.Methods The clinicopathological records and survival follow-up data of 2046 patients with localized renal cell carcinoma,who were treated with partial nephrectomy from August 2001 to February 2021 in the Department of Urology,Sun Yat-sen University Cancer Center,were retrospectively analyzed.There were 1402 males and 644 females,aged(M(IQR))51(19)years(range:6 to 86 years).The primary end point of this study was cancer-specific survival.Survival curves were estimated using the Kaplan-Meier method,and the difference test was performed by Log-rank test.Univariate and multivariate Cox analysis were fitted to determine factors associated with cancer-specific survival.Results The follow-up time was 49.2(48.0)months(range:1 to 229 months),with 1974 patients surviving and 72 dying.The median cancer-specific survival time has not yet been reached.The 5-and 10-year cancer specific survival rates were 97.0%and 91.2%,respectively.The 10-year cancer-specific survival rates for stage pT1a(n=1447),pT1b(n=523)and pT2(n=58)were 95.3%,81.8%,and 81.7%,respectively.The 10-year cancer-specific survival rates of patients with nuclear grade 1(n=226),2(n=1244)and 3 to 4(n=278)were 96.6%,89.4%,and 85.5%,respectively.There were no significant differences in 5-year cancer-specific survival rates among patients underwent open,laparoscopic,or robotic surgery(96.7%vs.97.1%vs.97.5%,P=0.600).Multivariate analysis showed that age≥50 years(HR=3.93,95%CI:1.82 to 8.47,P<0.01),T stage(T1b vs.T1a:HR=3.31,95%CI:1.83 to 5.99,P<0.01;T2+T3 vs.T1a:HR=2.88,95%CI:1.00 to 8.28,P=0.049)and nuclear grade(G3 to 4 vs.G1:HR=2.81,95%CI:1.01 to 7.82,P=0.048)were independent prognostic factors of localized renal cell carcinoma after partial nephrectomy.Conclusions The long-term cancer-specific survival rates of patients with localized renal cancer after partial nephrectomy are satisfactory.The type of operation(open,laparoscopic,or robotic)has no significant effect on survival.However,patients with older age,higher nuclear grade,and higher T stage have a lower cancer-specific survival rate.Grasping surgical indications,attaching importance to preoperative evaluation,perioperative management,and postoperative follow-up,could benefit achieving satisfactory long-term survival.