Overall survival and oncological outcomes after partial nephrectomy and radical nephrectomy for cT2a renal tumors: A collaborative international study from the French kidney cancer research network UroCCR.
Overall survival and oncological outcomes after partial nephrectomy and radical nephrectomy for cT2a renal tumors: A collaborative international study from the French kidney cancer research network UroCCR.
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DOI：
10.1016/j.purol.2017.12.004
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发表时间：
2018-03
影响因子：
1.1
通讯作者：
Flamand, V.
中科院分区：
文献类型：
--
作者：
Reix, B.;Bernhard, J. -C.;Patard, J. -J.;Bigot, P.;Villers, A.;Suer, E.;Vuong, N. S.;Verhoest, G.;Alimi, Q.;Beauval, J. -B.;Benoit, T.;Nouhaud, F. -X.;Lenormand, C.;Hamidi, N.;Cai, J.;Eto, M.;Larre, S.;El Bakhri, A.;Ploussard, G.;Hung, A.;Koutlidis, N.;Schneider, A.;Carrouget, J.;Droupy, S.;Marchal, S.;Doerfler, A.;Seddik, S.;Matsugasumi, T.;Orsoni, X.;Descazeaud, A.;Pfister, C.;Bensalah, K.;Soulie, M.;Gill, I.;Flamand, V.
部分肾切除术 (PN) 被推荐作为 cT1 期肾肿瘤的一线治疗，因为与根治性肾切除术 (RN) 相比，肾功能更好，总体生存率可能更高。对于较大的肿瘤，由于缺乏证据表明 PN 具有良好的癌症控制作用，因此其地位存在争议。本研究的目的是比较 cT2a 阶段 PN 和 RN 对总生存率和肿瘤学结果的影响。在法国肾癌研究网络（UroCCR）的框架内进行了一项回顾性国际多中心研究。我们考虑了2000年至2014年间所有年龄≥18岁、因局限性肾细胞癌（RCC）cT2a期（7.1-10 cm）接受手术治疗的患者。采用Cox和Fine-Gray模型来分析总生存期（OS）、癌症特异性生存期（CSS）和无癌生存期（CFS）。 PN 和 RN 之间的比较是在考虑预定义混杂因素的倾向评分调整后实现的：年龄、性别、肿瘤大小、TNM 分类的 pT 分期、组织学类型、ISUP 分级、ASA 评分。总共包括 267 名患者。 PN 后 3 年和 5 年的 OS 分别为 93.6% 和 78.7%，RN 后分别为 88.0% 和 76.2%。 PN 后 3 年和 5 年的 CSS 分别为 95.4% 和 80.2%，RN 后分别为 91.0% 和 85.0%。对 OS（HR 0.87，95% CI：0.37-2.05，P = 0.75）、CSS（HR 0.52，95% CI：0.18-1.54，P = 0.24）和 CFS（HR 1.02，95% CI：0.50-2.09，P = 0.24）进行倾向评分调整后，组间未发现显着差异。 0.96）。对于 cT2a 期肾肿瘤的 OS、CSS 和 CFS，PN 似乎与 RN 相当。复发风险可能与预后因素比手术技术更相关。无论是紧急情况还是选择性情况，是否进行 PN 的决定都应取决于技术可行性而不是肿瘤大小。 4.
Partial nephrectomy (PN) is recommended as first-line treatment for cT1 stage kidney tumors because of a better renal function and probably a better overall survival than radical nephrectomy (RN). For larger tumors, PN has a controversial position due to lack of evidence showing good cancer control. The aim of this study was to compare the results of PN and RN in cT2a stage on overall survival and oncological results. A retrospective international multicenter study was conducted in the frame of the French kidney cancer research network (UroCCR). We considered all patients aged ≥18 years who underwent surgical treatment for localized renal cell carcinoma (RCC) stage cT2a (7.1–10 cm) between 2000 and 2014. Cox and Fine-Gray models were performed to analyze overall survival (OS), cancer specific survival (CSS) and cancer-free survival (CFS). Comparison between PN and RN was realized after an adjustment by propensity score considering predefined confounding factors: age, sex, tumor size, pT stage of the TNM classification, histological type, ISUP grade, ASA score. A total of 267 patients were included. OS at 3 and 5 years was 93.6% and 78.7% after PN and 88.0% and 76.2% after RN, respectively. CSS at 3 and 5 years was 95.4% and 80.2% after PN and 91.0% and 85.0% after RN. No significant difference between groups was found after propensity score adjustment for OS (HR 0.87, 95% CI: 0.37–2.05, P = 0.75), CSS (HR 0.52, 95% CI: 0.18–1.54, P = 0.24) and CFS (HR 1.02, 95% CI: 0.50–2.09, P = 0.96). PN seems equivalent to RN for OS, CSS and CFS in cT2a stage kidney tumors. The risk of recurrence is probably more related to prognostic factors than the surgical technique. The decision to perform a PN should depend on technical feasibility rather than tumor size, both to imperative and elective situation. 4.
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影响因子：
6.6
作者：
Patard, JJ;Shvarts, O;Belldegrun, AS
通讯作者：
Belldegrun, AS
影响因子：
2.1
作者：
Jeldres, Claudio;Patard, Jean-Jacques;Karakiewicz, Pierre I.
通讯作者：
Karakiewicz, Pierre I.
影响因子：
4.5
作者：
Karellas ME;O'Brien MF;Jang TL;Bernstein M;Russo P
通讯作者：
Russo P
影响因子：
23.4
作者：
Weight, Christopher J.;Lieser, Gregory;Fergany, Amr F.
通讯作者：
Fergany, Amr F.
影响因子：
6.6
作者：
Kutikov, Alexander;Uzzo, Robert G.
通讯作者：
Uzzo, Robert G.