Comparison of outcomes in elective partial vs radical nephrectomy for clear cell renal cell carcinoma of 4-7 cm
Comparison of outcomes in elective partial vs radical nephrectomy for clear cell renal cell carcinoma of 4-7 cm
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DOI：
10.1111/j.1464-410x.2006.06060.x
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发表时间：
2006-05-01
影响因子：
4.5
通讯作者：
Russo, P
中科院分区：
文献类型：
--
作者：
Dash, A;Vickers, AJ;Russo, P
目的比较选择性肾部分切除术（PN）或根治性肾切除术（RN）的患者的结果为透明细胞肾细胞癌（RCC）的4-7 cm。患者和方法从1998年3月至2004年7月，45和151例患者进行PN和RN，分别为透明细胞RCC。一个多变量考克斯模型构建的无病生存与调整标志物的疾病严重程度，和一个倾向得分的方法作为一个验证性analysis.Results在PN和RN队列的治疗失败，分别在一个和20例患者，中位随访时间为21个月。调整疾病严重程度后，PN的风险比（95%置信区间）为0.36（0.05-2.82; P = 0.3）。使用计划PN作为预测因子（意向治疗分析），风险比为1.06（0.32-3.53; P = 0.9）。在倾向评分模型中，计划PN的风险比为1.75（0.50-6.14; P = 0.4）。术后3个月，PN组血肌酐水平明显低于对照组（P < 0.001），平均值为0.36（0.23-0.48; P < 0.001）。当比较PN和RN的结果时，重要的是要将预期的手术视为一个独立变量。没有明确的证据表明PN与更差的癌症控制相关，尽管需要对该队列和其他队列进行持续随访。
OBJECTIVE To compare the outcomes of patients who had a elective partial nephrectomy (PN) or radical nephrectomy (RN) for clear cell renal cell carcinoma (RCC) of 4-7 cm.PATIENTS AND METHODS From March 1998 to July 2004, 45 and 151 patients underwent PN and RN, respectively, for clear cell RCC. A multivariate Cox model was constructed for disease-free survival with adjustment for markers of disease severity, and a propensity-score approach used as a confirmatory analysis.Results In the PN and RN cohorts the treatment failed in one and 20 patients, respectively; the median follow-up was 21 months. The hazard ratio (95% confidence interval) for PN after adjusting for disease severity was 0.36 (0.05-2.82; P = 0.3). Using planned PN as a predictor (intent-to-treat analysis) the hazard ratio was 1.06 (0.32-3.53; P = 0.9). In the propensity-score model, planned PN was associated with a hazard ratio of 1.75 (0.50-6.14; P = 0.4). The serum creatinine level 3 months after surgery was significantly lower in patients who had PN, with a difference between the means of 0.36 (0.23-0.48; P < 0.001).Conclusions Renal function was preserved after PN for 4-7 cm clear cell RCC tumours. When comparing the outcomes of PN and RN it is important to consider the intended operation as an independent variable. There was no clear evidence that PN was associated with worse cancer control, although a continued follow-up of this and other cohorts is warranted.