肾部分切除术治疗cT_(1)N_(0)M_(0)期高恶性程度非透明细胞肾细胞癌的安全性和预后

Safety and prognostic analysis of partial nephrectomy for cT_(1)N_(0)M_(0)non-clear renal cell carcinoma with high grade malignancy

目的探讨肾部分切除术(PN)治疗高恶性程度非透明细胞肾细胞癌(nccRCC)的安全性和预后。方法回顾性分析2016年3月至2022年3月长海医院收治的47例cT_(1),N_(0)M_(0)期高恶性程度nccRCC患者的临床资料,男34例(72.3%),女13例(27.7%)。年龄(53.5±15.0)岁。体质量指数(23.7±3.4)kg/m^(2)。肿瘤最大径(29.8±12.6)mm。R.E.N.A.L.评分7(5,9)分。肿瘤分期T期37例(78.7%),Tb期10例(21.3%)。术前估算肾小球滤过率(eCFR)为(96.3±25.5)ml/(min·1.73m^(2))。所有患者均接受PN,其中开放手术1例(2.1%),腹腔镜手术29例(61.7%),机器人手术17例(36.2%)。记录手术中转率、手术时间、术中出血量、切缘阳性率、术后eCFR、并发症、术后住院时间,计算患者的总生存率(OS)和癌症特异性生存率(CSS)。结果本研究47例手术均顺利完成,无中转根治手术和开放手术。手术时间(100±60)min。术中出血量(100±59)ml。未发生术中并发症,术后并发症1例(2.1%)。术后病理诊断为IⅡI型乳头状肾细胞癌(pRCC)22例(46.8%),集合管癌(cdRCC)4例(8.5%),MiT家族易位肾细胞癌(tRCC)9例(19.1%),黏液样小管状和梭形细胞癌(mtSCC)5例(10.6%),未分类肾细胞癌(uRCC)7例(14.9%);切缘均为阴性。术后住院时间5(4,6)d。术后eGFR为(86.5±27.1)ml/(min·1.73m^(2)),与术前比较差异有统计学意义(P=0.041)。术后随访(45.7±20.9)个月,47例均未采用抗肿瘤相关辅助治疗,随访期内1例tRCC和1例cdRCC死亡,均为肾癌相关死亡。本组47例的OS和CSS均为95.7%(45/47)。结论PN治疗cT_(1)N_(0)M_(0)期高恶性程度nccRCC安全、可行。预后良好,对于影像学边界清晰、包膜完整的肿瘤,完整切除的可能性大,术后需严格随访,可以不行补救性根治手术或系统治疗。

Objective To investigate the safety and prognosis of partial nephrectomy(PN)in the treatment of highly malignant non-clear renal cell carcinoma(nccRCC).MethodssClinical data of 47 patients with cT_(1)N_(0)M_(0) high malignant nccRCC treated in Changhai Hospital from March 2016 to March 2022 were retrospectively analyzed.All patients received PN.There were 34(72.3%)males and 13(27.7%)females.The mean age was(53.5±15.0)years,and average BMI,was(23.7±3.4)kg/m^(2).The maximum tumor diameter was(29.8±12.6)mm,and R.E.N.A.L.score was 7(5-9),with 37(78.7%)cases of T_(1a) and 10(21.3%)cases of T_(1b) The mean estimated glomerular filtration rate(eGFR)before surgery was(96.3±25.5)ml/(min·1.73m^(2)).All patients underwent PN,including 1 patient(2.1%)undergoing open surgery,29 patients(61.7%)undergoing laparoscopic surgery,and 17 patients(36.2%)undergoing robotic surgery.There were a total of 22(46.8%)cases of papillary cell carcinoma(pRCC)type Ⅱ,4(8.5%)cases of collecting duct carcinoma(cdRCC),9(19.1%)cases of MiT family translocated renal cell carcinoma(tRCC),5(10.6%)cases of mucoid tubular and spindle cell carcinoma(mtSCC)and 7(14.9%)cases of unclassified renal cell carcinoma(uRCC).The surgical conversion rate,positive margin rate,operative time,intraoperative blood loss,complications,and postoperative hospital stay were analyzed.Preoperative and postoperative eGFR were analyzed,and overall survival(OS)and cancer specific survival(CSS)were calculated.Results All the operations were successfully completed.No radical operation or open operation was performed,with operation time of(100±60)min and intraoperative blood loss of(100±59)ml.There were no intraoperative complication and 1 case(2.1%)suffered from postoperative complication.Postoperative hospital stay were 5(4-6)days.The mean eGFR after surgery was(86.5±27.1)ml/(min·1.73m^(2)),and the difference was statistically significant(P=0.041).In this study,the mean follow-up time was(45.7±20.9)months,and no adjuvant therapy was used after surgery.During the follow-up period,2 patients died,who all of them were kidney cancer-related death,and both OS and CSS were 95.7%(45/47).Conclusions PN is safe,feasible and has a good prognosis in the treatment of high malignant T_(1)nccRCC.For tumors with clear imaging boundaries and complete envelope,complete tumor resection is more likely,postoperative follow-up should be strict,and no remedial radical or systemic treatment was required.