BACKGROUND Renal cell carcinoma(RCC)is the third most common malignancy in the genitourinary tract.The lungs,bone,lymph nodes,liver,and brain are common metastatic sites of RCC.However,there is limited literature on s...BACKGROUND Renal cell carcinoma(RCC)is the third most common malignancy in the genitourinary tract.The lungs,bone,lymph nodes,liver,and brain are common metastatic sites of RCC.However,there is limited literature on single omental metastasis of RCC.CASE SUMMARY We present the case of a 44-year-old man with single omental metastasis of RCC after laparoscopic radical nephrectomy.Pathological diagnosis of the resected left kidney revealed pT3a clear cell RCC(Fuhrman grade III).At 6 mo postoperatively,abdominal computed tomography revealed a 12-mm enhancing nodule in the left lower peritoneum.At 7 mo after initial operation,laparoscopic removal of the left omental nodule was performed.The pathological results indicated metastatic clear cell RCC.Currently,the patient is being treated with adjuvant pembrolizumab.CONCLUSION Omental metastasis of RCC owing to laparoscopic radical nephrectomy is rare.Urologists should be aware of the diverse nature of RCC.展开更多
Background and Objective: The most effective therapy against renal cell carcinoma (RCC) is surgical treatment; however, there have been few large-scale studies that focused on the oncological outcome of this disease i...Background and Objective: The most effective therapy against renal cell carcinoma (RCC) is surgical treatment; however, there have been few large-scale studies that focused on the oncological outcome of this disease in China. The aim of the current study was to report the clinicopathological results and cancer-specific survival (CSS) rate in RCC patients after surgical treatment in our center. Methods: We retrospectively analyzed the clinicopathological data of 336 RCC patients who underwent radical or partial nephrectomy between 1999 and 2006. Of the 336 patients, 226 were male and 110 were female; the median age was 51 years. Univariate and multivariate analyses were conducted to identify the independent prognostic predictors for this cohort of RCC patients. Results: During follow-up, the overall 5-year CSS rate was 81.4%. The 5-year CSS rates for patients with stage-I, -II, -III, and -IV RCC were 94.7%, 88.9%, 68.8%, and 19.3%, respectively. The patients with T1N0M0 (T1) and T2N0M0 (T2) tumors had similar survival curves. For patients with T1 category tumor, the survival rate did not differ significantly between the radical nephrectomy and nephron-sparing surgery groups. For the 21 patients with metastasis confined to the local lymph nodes, the 5-year survival rate was 31.6% after radical nephrectomy and lymph node dissection. For the 15 patients with vena caval tumor thrombus, the 5-year survival rate was 52.5% after radical nephrectomy and tumor thrombus extirpation. Multivariate Cox regression showed that stage was an independent predictor for CSS (hazard ratio, 3.359; P < 0.001). Conclusions: For localized RCC, the oncological outcome of this cohort is comparable to that reported in the Western literature. For some patients with locally advanced RCC, aggressive surgical treatment can lead to better long-term survival. However, the prognosis of the patients with metastasis still needs to be improved.展开更多
Objective:The role of lymph node dissection(LND)is still controversial in patients with renal cell carcinoma undergoing surgery.We aimed to provide a comprehensive review of the literature about the effect of LND on s...Objective:The role of lymph node dissection(LND)is still controversial in patients with renal cell carcinoma undergoing surgery.We aimed to provide a comprehensive review of the literature about the effect of LND on survival,prognosis,surgical outcomes,as well as patient selection and available LND templates.Methods:Recent literature(from January 2011 to December 2021)was assessed through PubMed and MEDLINE databases.A narrative review of most relevant articles was provided.Results:The frequencies in which LNDs are being carried out are decreasing due to an increase in minimally invasive and nephron sparing surgery.Moreover,randomized clinical trials and meta-analyses failed to show any survival advantage of LND versus no LND.However,retrospective studies suggest a survival benefit of LND in high-risk patients(bulky tumors,T3-4 stage,and cN1 patients).Moreover,extended LND might provide important staging information,which could be of interest for adjuvant treatment planning.Conclusion:No level 1 evidence of any survival advantage deriving from LND is currently available in literature.Thus,the role of LND is limited to staging purposes.However,low grade evidence suggests a possible role of LND in high-risk patients.Randomized clinical trials are warranted to corroborate these findings.展开更多
目的比较单孔腹腔镜根治性肾切除术(LESS-RN)与传统腹腔镜根治性肾切除术(CL-RN)后至少10年的局限性肾癌患者肿瘤疗效和肾功能结局。方法选取2009-2012年在海军军医大学(第二军医大学)第一附属医院接受LESS-RN或CL-RN治疗的T1a~T2a期局...目的比较单孔腹腔镜根治性肾切除术(LESS-RN)与传统腹腔镜根治性肾切除术(CL-RN)后至少10年的局限性肾癌患者肿瘤疗效和肾功能结局。方法选取2009-2012年在海军军医大学(第二军医大学)第一附属医院接受LESS-RN或CL-RN治疗的T1a~T2a期局限性肾癌患者,按患者年龄、BMI、肿瘤大小进行倾向评分匹配,共纳入31对患者,分析患者的基线特征、手术数据、病理结果和随访信息,以评估LESS-RN和CL-RN的长期预后差异。结果LESS-RN组与CL-RN组患者在手术时间[(179.7±43.0)min vs(172.6±50.9)min,P=0.349]、估计失血量[100(50,200)mL vs 100(50,150)mL,P=0.871]、住院时间[6(5,7)d vs 7(6,9)d,P=0.080]方面差异均无统计学意义。LESS-RN组有1例患者发生术中并发症,没有患者发生术后并发症;CL-RN组有1例患者发生术中并发症,3例患者发生术后并发症。LESS-RN组随访时间为(138.0±9.0)个月,CL-RN组为(137.8±9.8)个月(P=0.730)。LESS-RN组与CL-RN组患者总生存率(80.6%vs 74.2%,P=0.181)、肿瘤特异性生存率(93.6%vs 96.8%,P=0.554)、血肌酐变化水平[32(17,45)μmol/L vs 20(5,47)μmol/L,P=0.098]和估算的肾小球滤过率[(60.2±20.9)mL·min^(-1)·(1.73 m^(2))^(-1) vs(66.7±27.8)mL·min^(-1)·(1.73 m^(2))^(-1),P=0.342]差异均无统计学意义。结论LESS-RN是一种安全、可行的治疗局限性肾癌的手术方法,其长期肿瘤疗效和肾功能结局与CL-RN相当。展开更多
Objectives This study compared the long-term efficacy and prognostic factors of partial nephrectomy (PN) and radical nephrectomy (RN) for T1bN0M0 renal cell carcinoma (RCC) using data from the Surveillance, Epidemiolo...Objectives This study compared the long-term efficacy and prognostic factors of partial nephrectomy (PN) and radical nephrectomy (RN) for T1bN0M0 renal cell carcinoma (RCC) using data from the Surveillance, Epidemiology, and End Results database.Materials and methods We retrospectively analyzed the clinical data of 12,471 patients diagnosed with T1bN0M0 RCC from the Surveillance, Epidemiology, and End Results database between 2010 and 2019. Patients were divided into the PN and RN groups, and propensity score matching was conducted to balance the differences between the groups. We compared overall survival (OS), RCC cancer–specific mortality (CSM), and noncancer-specific mortality (NCSM) between the 2 groups. The risk factors for all-cause and RCC-related mortality were analyzed.Results After propensity score matching, there were 3817 patients in each group. After matching, OS and NCSM were significantly longer in the PN group (p < 0.001);however, there was no significant between-group difference in the RCC-CSM. The hazard ratio (HR) for all-cause mortality was significantly lower in the PN group (HR, 0.671;95% confidence interval [CI], 0.579–0.778, p < 0.001), but PN was not associated with lower RCC-related mortality. Subgroup analysis showed that PN reduced the HR of all-cause mortality by 35% (HR, 0.647;95% CI, 0.536–0.781;p < 0.001) in patients with 4.0- to 5.5-cm tumors compared with RN and by 29% (HR, 0.709;95% CI, 0.559–0.899;p = 0.004) in those with larger tumors (5.6–7.0 cm). Multifactorial analysis showed that PN was an independent predictor of OS (HR, 0.671;95% CI, 0.579–0.778;p < 0.001). In addition, multivariate analysis validated that age at diagnosis, sex, pathological grade, and tumor size were associated with outcomes.Conclusions In patients with T1b RCC, PN resulted in better OS and NCSM outcomes than RN. The benefit of PN in all-cause mortality was pronounced in patients with 4.0–5.5 cm tumor loads. Therefore, individualized treatment schemes should prioritize PN, when technically feasible.展开更多
目的系统评价局限性肾癌患者行肾部分切除术和根治性肾切除术的肿瘤预后。方法检索Cochrane图书馆、Medline、Embase、Web of Science和CNKI中国期刊全文数据库2014年5月前国内外公开发表的比较肾部分切除术（PN）与肾癌根治术（RN）治...目的系统评价局限性肾癌患者行肾部分切除术和根治性肾切除术的肿瘤预后。方法检索Cochrane图书馆、Medline、Embase、Web of Science和CNKI中国期刊全文数据库2014年5月前国内外公开发表的比较肾部分切除术（PN）与肾癌根治术（RN）治疗局限性肾癌的肿瘤预后的临床对照研究,进行系统评价。结果按照纳入与排除标准,最终纳入文献33篇,共33 520例,PN和RN手术分别为9 190例和24 340例。PN与RN的术后5年总的生存率（OS）、5年肿瘤特异性生存率（CSS）、并发症发生率和慢性肾脏病发生率的相对危险度分别为1.037（95%CI：1.023-1.050）、1.022（95%CI：1.006-1.038）、1.397（95%CI：1.078-1.811）、0.416（95%CI：0.295-0.587）,差异均有统计学意义（P〈0.05）。术后10年总的生存率、10年肿瘤特异性生存率、肿瘤复发率和肿瘤转移率的相对危险度分别为：1.046（95%CI：1.020-1.073）、1.018（95%CI：0.992-1.043）、1.375（95%CI：0.920-2.057）、0.520（95%CI：0.260-1.039）,差异均无统计学意义（P〉0.05）。结论对于局限性肾癌患者,PN的术后5年的生存预后优于RN,而两种手术方式的术后10年的生存预后相当,并且肿瘤复发情况与转移情况无明显差异。虽然PN的并发症发生率较RN高,但PN在慢性肾脏病发生率方面明显低于RN,所以PN是一种疗效显著并且有其自身优势的手术方法,值得在临床上推广。展开更多
文摘BACKGROUND Renal cell carcinoma(RCC)is the third most common malignancy in the genitourinary tract.The lungs,bone,lymph nodes,liver,and brain are common metastatic sites of RCC.However,there is limited literature on single omental metastasis of RCC.CASE SUMMARY We present the case of a 44-year-old man with single omental metastasis of RCC after laparoscopic radical nephrectomy.Pathological diagnosis of the resected left kidney revealed pT3a clear cell RCC(Fuhrman grade III).At 6 mo postoperatively,abdominal computed tomography revealed a 12-mm enhancing nodule in the left lower peritoneum.At 7 mo after initial operation,laparoscopic removal of the left omental nodule was performed.The pathological results indicated metastatic clear cell RCC.Currently,the patient is being treated with adjuvant pembrolizumab.CONCLUSION Omental metastasis of RCC owing to laparoscopic radical nephrectomy is rare.Urologists should be aware of the diverse nature of RCC.
文摘Background and Objective: The most effective therapy against renal cell carcinoma (RCC) is surgical treatment; however, there have been few large-scale studies that focused on the oncological outcome of this disease in China. The aim of the current study was to report the clinicopathological results and cancer-specific survival (CSS) rate in RCC patients after surgical treatment in our center. Methods: We retrospectively analyzed the clinicopathological data of 336 RCC patients who underwent radical or partial nephrectomy between 1999 and 2006. Of the 336 patients, 226 were male and 110 were female; the median age was 51 years. Univariate and multivariate analyses were conducted to identify the independent prognostic predictors for this cohort of RCC patients. Results: During follow-up, the overall 5-year CSS rate was 81.4%. The 5-year CSS rates for patients with stage-I, -II, -III, and -IV RCC were 94.7%, 88.9%, 68.8%, and 19.3%, respectively. The patients with T1N0M0 (T1) and T2N0M0 (T2) tumors had similar survival curves. For patients with T1 category tumor, the survival rate did not differ significantly between the radical nephrectomy and nephron-sparing surgery groups. For the 21 patients with metastasis confined to the local lymph nodes, the 5-year survival rate was 31.6% after radical nephrectomy and lymph node dissection. For the 15 patients with vena caval tumor thrombus, the 5-year survival rate was 52.5% after radical nephrectomy and tumor thrombus extirpation. Multivariate Cox regression showed that stage was an independent predictor for CSS (hazard ratio, 3.359; P < 0.001). Conclusions: For localized RCC, the oncological outcome of this cohort is comparable to that reported in the Western literature. For some patients with locally advanced RCC, aggressive surgical treatment can lead to better long-term survival. However, the prognosis of the patients with metastasis still needs to be improved.
文摘Objective:The role of lymph node dissection(LND)is still controversial in patients with renal cell carcinoma undergoing surgery.We aimed to provide a comprehensive review of the literature about the effect of LND on survival,prognosis,surgical outcomes,as well as patient selection and available LND templates.Methods:Recent literature(from January 2011 to December 2021)was assessed through PubMed and MEDLINE databases.A narrative review of most relevant articles was provided.Results:The frequencies in which LNDs are being carried out are decreasing due to an increase in minimally invasive and nephron sparing surgery.Moreover,randomized clinical trials and meta-analyses failed to show any survival advantage of LND versus no LND.However,retrospective studies suggest a survival benefit of LND in high-risk patients(bulky tumors,T3-4 stage,and cN1 patients).Moreover,extended LND might provide important staging information,which could be of interest for adjuvant treatment planning.Conclusion:No level 1 evidence of any survival advantage deriving from LND is currently available in literature.Thus,the role of LND is limited to staging purposes.However,low grade evidence suggests a possible role of LND in high-risk patients.Randomized clinical trials are warranted to corroborate these findings.
文摘目的比较单孔腹腔镜根治性肾切除术(LESS-RN)与传统腹腔镜根治性肾切除术(CL-RN)后至少10年的局限性肾癌患者肿瘤疗效和肾功能结局。方法选取2009-2012年在海军军医大学(第二军医大学)第一附属医院接受LESS-RN或CL-RN治疗的T1a~T2a期局限性肾癌患者,按患者年龄、BMI、肿瘤大小进行倾向评分匹配,共纳入31对患者,分析患者的基线特征、手术数据、病理结果和随访信息,以评估LESS-RN和CL-RN的长期预后差异。结果LESS-RN组与CL-RN组患者在手术时间[(179.7±43.0)min vs(172.6±50.9)min,P=0.349]、估计失血量[100(50,200)mL vs 100(50,150)mL,P=0.871]、住院时间[6(5,7)d vs 7(6,9)d,P=0.080]方面差异均无统计学意义。LESS-RN组有1例患者发生术中并发症,没有患者发生术后并发症;CL-RN组有1例患者发生术中并发症,3例患者发生术后并发症。LESS-RN组随访时间为(138.0±9.0)个月,CL-RN组为(137.8±9.8)个月(P=0.730)。LESS-RN组与CL-RN组患者总生存率(80.6%vs 74.2%,P=0.181)、肿瘤特异性生存率(93.6%vs 96.8%,P=0.554)、血肌酐变化水平[32(17,45)μmol/L vs 20(5,47)μmol/L,P=0.098]和估算的肾小球滤过率[(60.2±20.9)mL·min^(-1)·(1.73 m^(2))^(-1) vs(66.7±27.8)mL·min^(-1)·(1.73 m^(2))^(-1),P=0.342]差异均无统计学意义。结论LESS-RN是一种安全、可行的治疗局限性肾癌的手术方法,其长期肿瘤疗效和肾功能结局与CL-RN相当。
基金Shandong Provincial Nature Science Foundation(ZR2020QH240)National Nature Science Foundation of China(NSFC82002719)+1 种基金Clinical Medicine Innovation Program of Jinan City(202019125)China Postdoctoral Science Foundation(2022M711977).
文摘Objectives This study compared the long-term efficacy and prognostic factors of partial nephrectomy (PN) and radical nephrectomy (RN) for T1bN0M0 renal cell carcinoma (RCC) using data from the Surveillance, Epidemiology, and End Results database.Materials and methods We retrospectively analyzed the clinical data of 12,471 patients diagnosed with T1bN0M0 RCC from the Surveillance, Epidemiology, and End Results database between 2010 and 2019. Patients were divided into the PN and RN groups, and propensity score matching was conducted to balance the differences between the groups. We compared overall survival (OS), RCC cancer–specific mortality (CSM), and noncancer-specific mortality (NCSM) between the 2 groups. The risk factors for all-cause and RCC-related mortality were analyzed.Results After propensity score matching, there were 3817 patients in each group. After matching, OS and NCSM were significantly longer in the PN group (p < 0.001);however, there was no significant between-group difference in the RCC-CSM. The hazard ratio (HR) for all-cause mortality was significantly lower in the PN group (HR, 0.671;95% confidence interval [CI], 0.579–0.778, p < 0.001), but PN was not associated with lower RCC-related mortality. Subgroup analysis showed that PN reduced the HR of all-cause mortality by 35% (HR, 0.647;95% CI, 0.536–0.781;p < 0.001) in patients with 4.0- to 5.5-cm tumors compared with RN and by 29% (HR, 0.709;95% CI, 0.559–0.899;p = 0.004) in those with larger tumors (5.6–7.0 cm). Multifactorial analysis showed that PN was an independent predictor of OS (HR, 0.671;95% CI, 0.579–0.778;p < 0.001). In addition, multivariate analysis validated that age at diagnosis, sex, pathological grade, and tumor size were associated with outcomes.Conclusions In patients with T1b RCC, PN resulted in better OS and NCSM outcomes than RN. The benefit of PN in all-cause mortality was pronounced in patients with 4.0–5.5 cm tumor loads. Therefore, individualized treatment schemes should prioritize PN, when technically feasible.
