Safety and efficacy of partial nephrectomy for all T1 tumors based on an international multicenter experience
Safety and efficacy of partial nephrectomy for all T1 tumors based on an international multicenter experience
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DOI：
10.1097/01.ju.0000124846.37299.5e
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发表时间：
2004-06-01
影响因子：
6.6
通讯作者：
Belldegrun, AS
中科院分区：
文献类型：
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作者：
Patard, JJ;Shvarts, O;Belldegrun, AS
目的：我们根据大型多中心系列中的肿瘤大小比较了接受部分和自由基肾脏的癌症患者的癌症特异性生存。材料和方法：对1,454例对7个国际肾脏肾切除术进行T1N0M0肾脏切除术的回顾性分析。进行了学术中心。获得了每个患者的数据，包括TNM阶段（根据2002 TNM标准确定），肿瘤大小，手术类型（部分肾切除术与自由基切除术）和特定于癌症的生存率。可用时记录了复发事件：分别在379（26.1％）和1,075例（73.9％）病例中进行部分和自由基肾切除术。平均随访+/- SD为62.5 +/- 51.8个月。 544名患者可获得复发数据。 T1A（P = 0.6）或T1B肿瘤（P = 0.5），接受部分或自由基肾切除术的患者之间的局部或远处复发率无显着差异。对于T1a肿瘤的患者，部分（314）和自由基（499）肾切除术组之间的癌症特异性死亡率没有显着差异（分别为2.2％和2.6％，P = 0.8）。对于T1B肿瘤的患者，接受部分癌症（65）和接受自由基（576）肾切除术的患者（65）患者（分别为6.2％对9％，P = 0.6）也没有显着差异。结论：结论：肾切除术已成为小于4 cm的肾脏肿瘤的黄金标准，但对于较大的T1肿瘤而言，这种治疗方法更具争议性。这项大型多中心研究表明，扩大部分肾切除术的适应症是安全的，以包括最高7 cm的T1N0M0肿瘤患者。但是，仍然有必要仔细的患者选择。
Purpose: We compared cancer specific survival of patients undergoing partial and radical nephrectomies for T1N0M0 renal tumors according to tumor size in a large multicenter series.Materials and Methods: A retrospective analysis of 1,454 patients undergoing partial or radical nephrectomy for T1N0M0 renal tumors from 7 international academic centers was performed. Data were obtained for each patient including TNM stage (determined according to the 2002 TNM criteria), tumor size, type of surgery (partial versus radical nephrectomy) and cancer specific survival. Recurrence events were recorded when available.Results: Partial and radical nephrectomies were performed in 379 (26.1%) and 1,075 (73.9%) cases, respectively. Mean followup +/- SD was 62.5 +/- 51.8 months. Recurrence data were available on 544 patients. There were no significant differences in local or distant recurrence rates between patients undergoing partial or radical nephrectomy for either T1a (p = 0.6) or T1b tumors (p = 0.5). For patients with T1a tumors, there was no significant difference in the rate of cancer specific deaths between the partial (314) and radical (499) nephrectomy groups (2.2% versus 2.6%, respectively, p = 0.8). For patients with T1b tumors there was also no significant difference in the rate of cancer specific deaths between patients undergoing partial (65) and patients undergoing radical (576) nephrectomy (6.2% versus 9%, respectively, p = 0.6).Conclusions: Partial nephrectomy is becoming the gold standard for renal tumors less than 4 cm but this treatment is much more controversial for larger T1 tumors. This large multicenter study suggests that it is safe to expand the indications of partial nephrectomy to include patients with T1N0M0 tumors up to 7 cm. However, careful patient selection remains necessary.