根治性肾切除术与肾部分切除术治疗Ⅲ期肾透明细胞癌的效果比较

Comparison of curative effects of radical nephrectomy versus partial nephrectomy on stageⅢrenal clear cell carcinoma

目的比较根治性肾切除术(RN)与肾部分切除术(PN)治疗Ⅲ期肾透明细胞癌的效果。方法回顾性分析2013-2018年在郑州大学第一附属医院进行手术治疗的Ⅲ期肾透明细胞癌患者的临床资料及随访数据,共48例患者纳入最终研究,其中PN组16例,RN组32例。应用Kaplan-Meier比较RN组与PN组患者的生存差异。检索美国国立癌症研究所(SEER)数据库最新公布的2010-2015年成人(大于18岁)单侧、原发、不合并其他肿瘤Ⅲ期肾透明细胞癌患者数据。将患者分为PN组与RN组,采用倾向评分匹配法(1∶1)校正基线肿瘤数目、肿瘤长径、年龄、T分期、N分期、组织学分级差异。采用Kaplan-Meier生存分析检验两组间生存期差异。采用COX回归分析影响患者预后的独立危险因素。结果纳入最终研究的48例患者中,男32例,女16例,年龄(66.13±12.91)岁,随访时间(34.25±19.43)个月,PN组16例,RN组32例,两组年龄、性别、T分期、N分期、肿瘤大小、肿瘤数目比较,差异均未见统计学意义(P>0.05)。PN组孤立肾6例,高于RN组,差异有统计学意义(P<0.05),两组5年生存率比较差异未见统计学意义(P>0.05);Kaplan-Meier生存分析显示,PN组与RN组肿瘤特异性生存期比较,差异未见统计学意义(P=0.599>0.05)。SEER数据库中共1114例患者纳入最终研究,RN组与PN组各557例。Kaplan-Meier生存分析显示,PN组肿瘤特异性生存期优于RN组,差异有统计学意义(P<0.001)。COX多因素分析显示,高龄(HR=1.046,95%CI:1.031~1.062)、高病理分级(HR=1.426,95%CI:1.017~1.999)、N_(1)(HR=1.950,95%CI:1.159~2.282)、肿瘤长径大于>70 mm(HR=1.914,95%CI:1.213~3.021)、RN(HR=2.082,95%CI:1.414~3.065)是Ⅲ期肾透明细胞癌患者肿瘤特异性生存期的独立危险因素。结论PN治疗Ⅲ期肾透明细胞癌患者肿瘤特异性生存期优于RN,RN是Ⅲ期肾透明细胞癌患者肿瘤特异性生存期的独立危险因素。

Objective To compare the effects of radical nephrectomy(RN)and partial nephrectomy(PN)on stageⅢrenal clear cell carcinoma.Methods The clinical data and follow⁃up data of patients with stageⅢrenal clear cell carcinoma treated surgically in the First Affiliated Hospital of Zhengzhou University from 2013 to 2018 were retrospectively analyzed.A total of 48 patients were included in the final study,including 16 patients in the PN group and 32 patients in the RN group.Kaplan⁃Meier was used to compare the survival difference between the RN group and the PN group.The data on unilateral,primary,uncomplicated stageⅢrenal clear cell carcinoma in adults(older than 18 years)from 2010⁃2015 were retrieved from the National Cancer Institute(SEER)database.Propensity score matching method(1∶1)was used to adjust the difference of baseline tumor number,tumor length,age,T stage,N stage,and histological grade.Kaplan⁃Meier survival analysis was used to examine the difference in survival between the two groups.COX regression was used to analyze the independent risk factors affecting the prognosis of patients.Results A total of 48 patients were included in the final study,including 16 cases in the PN group and 32 cases in the RN group,including 32 males and 16 females,with an average age of(66.13±12.91)years and an average follow⁃up time of(34.25±19.43)months.There was no significant differences in age,gender,T stage,N stage,tumor size,or tumor number between the two groups(P>0.05).There were 6 cases of isolated kidney in the PN group,which was higher than that in the RN group(P<0.05).There was no significant difference in the 5⁃year survival rate between the two groups(P>0.05).Kaplan Meier survival analysis showed no significant difference in tumor specific survival between the PN group and the RN group(P=0.599>0.05).A total of 1114 patients in the SEER database were included in the final study,557 patients in the RN group and 557 patients in the PN group.Kaplan⁃Meier survival analysis showed that the tumor⁃specific survival in PN group was better than that in RN group(P<0.001).COX multivariate analysis showed that old age(HR=1.046,95%CI:1.031⁃1.062)and high pathological grade(HR=1.426,95%CI:1.017⁃1.999),N_(1)(HR=1.950,95%CI:1.159⁃2.282),tumor diameter greater than>70 mm(HR=1.914,95%CI:1.213⁃3.021),RN(HR=2.082,95%CI:1.414⁃3.065)were independent risk factors for tumor⁃specific survival in patients with stageⅢrenal clear cell carcinoma.Conclusions The tumor⁃specific survival of patients with stageⅢrenal clear cell carcinoma treated by PN is superior to RN,RN is an independent risk factor for tumor⁃specific survival of patients with stageⅢrenal clear cell carcinoma.