Partial Nephrectomy Is Associated with Improved Overall Survival Compared to Radical Nephrectomy in Patients with Unanticipated Benign Renal Tumours
Partial Nephrectomy Is Associated with Improved Overall Survival Compared to Radical Nephrectomy in Patients with Unanticipated Benign Renal Tumours
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DOI：
10.1016/j.eururo.2010.04.033
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发表时间：
2010-08-01
期刊：
影响因子：
23.4
通讯作者：
Fergany, Amr F.
中科院分区：
文献类型：
--
作者：
Weight, Christopher J.;Lieser, Gregory;Fergany, Amr F.
背景：与根治性肾切除术（RN）相比，部分肾切除术（PN）可提高局部肾肿块患者的总生存率（OS）。考虑到先前比较的队列的异质性，这些差异背后的驱动力很难阐明。目的：比较一组未预料到的良性肾肿块患者的OS，以尽量减少癌症的混杂效应。设计、环境和参与者：我们回顾性评估了1999年至2006年在我院接受摘除手术治疗的2608例连续临床T1增强肾肿块。其中499例肿瘤（19%）在最终病理检查中为良性。术前数据和肾功能数据用于生成倾向模型，然后将其插入到多变量生存模型中。整个队列的中位随访时间为50个月（四分位数间距[IQR]: 32-73）。干预：所有患者均行PN或RN。测量：我们测量了总生存期和心脏特异性生存期。结果和局限性：PN组（n = 388）和RN组（n = 111）的5年OS估计分别为95%（95%可信区间[CI]， 93-98）和83% (95% CI, 74-90) （P < 0.0001）。在多变量分析中，在控制合并症和年龄的情况下，与PN相比，RN与死亡风险增加2.5倍相关（危险比[HR]: 2.5; 95% CI, 1.3-5.1）。术后估计肾小球滤过率（eGFR）也是OS和心脏特异性生存的独立预测因子（HR: 0.97; 95% CI, 0.95-0.99; HR: 0.96; 95% CI, 0.93-0.99）。该分析的回顾性性质限制了结论的强度。结论：与非预期良性肿瘤患者的RN相比，PN与更好的OS相关。这种观察到的生存优势似乎部分是eGFR保存更好的结果，但其他肾脏功能或未测量的因素也可能起作用。这些数据表明，在技术上可行的情况下，任何患者都应积极追求PN。(C) 2010年欧洲泌尿外科协会。Elsevier B.V.版权所有。
Background: Partial nephrectomy (PN) has been associated with improved overall survival (OS) in select cohorts with localised renal masses when compared to radical nephrectomy (RN). The driving forces behind these differences have been difficult to elucidate given the heterogeneity of previously compared cohorts.Objective: Compare OS in a subset of patients with unanticipated benign renal masses to minimise the confounding effect of cancer.Design, setting, and participants: We retrospectively evaluated 2608 consecutive clinical T1 enhancing renal masses that were treated with extirpative surgery at our institution between 1999 and 2006. Of these, 499 tumours (19%) were found to be benign on final pathology. Preoperative data and renal functional data were used to generate a propensity model that was then plugged into a multivariate model of survival. Median follow-up for the entire cohort was 50 mo (interquartile range [IQR]: 32-73).Intervention: All patients underwent PN or RN.Measurements: We measured OS and cardiac-specific survival.Results and limitations: Five-year OS estimates for the PN (n = 388) and RN (n = 111) cohorts were 95% (95% confidence interval [CI], 93-98) versus 83% (95% CI, 74-90), respectively (P < 0.0001). On multivariate analysis, controlling for both comorbidity and age, RN was associated with a 2.5-fold increased risk of death compared to PN (hazard ratio [HR]: 2.5; 95% CI, 1.3-5.1). Postoperative estimated glomerular filtration rate (eGFR) was also an independent predictor of OS and cardiac-specific survival (HR: 0.97; 95% CI, 0.95-0.99 and HR: 0.96; 95% CI, 0.93-0.99, respectively). The retrospective nature of this analysis limits the strength of the conclusions.Conclusions: PN was associated with better OS when compared to RN in patients with unanticipated benign tumours. This observed survival advantage appears partly to be the result of better preservation of eGFR, but other kidney functions or unmeasured factors may also play a role. These data indicate that PN should be aggressively pursued in any patient where PN is technically feasible. (C) 2010 European Association of Urology. Published by Elsevier B.V. All rights reserved.