Radical nephrectomy for pT1a renal masses may be associated with decreased overall survival compared with partial nephrectomy
Radical nephrectomy for pT1a renal masses may be associated with decreased overall survival compared with partial nephrectomy
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DOI：
10.1016/j.juro.2007.09.077
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发表时间：
2008-02-01
影响因子：
6.6
通讯作者：
Blute, Michael L.
中科院分区：
文献类型：
--
作者：
Thompson, R. Houston;Boorjian, Stephen A.;Blute, Michael L.
目的：我们回顾了我们的手术经验与小的肾肿瘤，比较根治性和肾部分切除术治疗的患者的总体生存率。材料和方法：使用我们的肾切除术注册表，我们确定了散发性，单侧，孤立性和局部肾肿块4厘米或更小的患者进行根治性或肾部分切除术在1989年和2003年之间。孤立肾或肾功能受损的患者被排除在外，剩下648例可用于分析。使用Kaplan-Meier方法估计总生存率，并使用考克斯比例风险回归法评估与死亡的相关性。结果：在最后一次随访时，146例患者死于任何原因，502例存活，中位生存期为7.1年。根治性肾切除术290例，肾部分切除术358例。在所有患者中，与肾部分切除术相比，根治性肾切除术与任何原因的死亡均无显著相关性（RR 1.12，p = 0.52）。然而，与年龄有显着的相互作用，导致我们在65岁的中位年龄对我们的分析进行分层。在327例年龄小于65岁的患者中，与肾部分切除术相比，根治性肾切除术与全因死亡显著相关（RR 2.16，p = 0.02）。在调整手术年数后，死亡风险的增加仍然存在（p = 0.02），术前肌酐（p = 0.03），Charlson-Romano指数（p = 0.04），就诊时的症状（p = 0.02），就诊时患有糖尿病（p = 0.03）和组织学（p = 0.02）。我们的研究结果表明，与肾部分切除术相比，根治性肾切除术与较小肾脏肿块的年轻患者总体生存率降低相关。
Purpose: We reviewed our surgical experience with small renal tumors, comparing overall survival in patients treated with radical and partial nephrectomy.Materials and Methods: Using our nephrectomy registry we identified patients with sporadic, unilateral, solitary and localized renal masses 4 cm or less who underwent radical or partial nephrectomy between 1989 and 2003. Patients with a solitary kidney or impaired renal function at presentation were excluded, leaving 648 available for analysis. Overall survival was estimated using the Kaplan-Meier method and associations with death were evaluated using Cox proportional hazards regression.Results: At last followup 146 patients had died of any cause and 502 were alive at a median of 7.1 years. Radical and partial nephrectomy was performed in 290 and 358 patients, respectively. In all patients radical nephrectomy was not significantly associated with death from any cause compared with partial nephrectomy (RR 1.12, p = 0.52). However, there was a significant interaction with age, leading us to stratify our analysis at the median age of 65 years. In 327 patients younger than 65 years radical nephrectomy was significantly associated with death from any cause compared with partial nephrectomy (RR 2.16, p = 0.02). The increased risk of death persisted after adjusting for year of surgery (p = 0.02), preoperative creatinine (p = 0.03), Charlson-Romano index (p = 0.04), symptoms at presentation (p = 0.02), diabetes at presentation (p = 0.03) and histology (p = 0.02).Conclusions: Our results suggest that, compared with partial nephrectomy, radical nephrectomy is associated with decreased overall survival in younger patients with small renal masses.