Partial Versus Radical Nephrectomy in Patients With Adverse Clinical or Pathologic Characteristics
Partial Versus Radical Nephrectomy in Patients With Adverse Clinical or Pathologic Characteristics
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DOI：
10.1016/j.urology.2008.08.492
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发表时间：
2009-06-01
期刊：
影响因子：
2.1
通讯作者：
Karakiewicz, Pierre I.
中科院分区：
文献类型：
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作者：
Jeldres, Claudio;Patard, Jean-Jacques;Karakiewicz, Pierre I.
为了评估肿瘤特异性生存的肾部分切除术（PN）患者>= 7厘米病变或不利的病理（T3 a期或Fuhrman等级III-IV）。材料和方法在13个参与中心，4072部分或根治性肾切除术（RN）进行RCC在1984年和2001年之间。在所有手术中，925例（22.7%）为> 7 cm的肿瘤，973例（23.9%）为Fuhrman III或IV级，861例（21.1%）为pT 3a期。无淋巴结或远处转移。匹配的（年龄、性别、肿瘤大小、T分期、组织学亚型和Fuhrman分级[FG]）生存分析阐明了肾切除术类型（部分与根治性）对癌症特异性死亡率的影响。结果肿瘤> 7 cm的肾部分切除术死亡率高于RN（HR = 5.3; P = 0.025）。PN后FG III-IV（HR = 0.7，P = 0.5）或pT 3a病变（HR = 2.5，P = 0.9）的肿瘤特异性生存率无显著差异。结论肾部分切除术可能破坏肿瘤> 7 cm患者的癌症控制。相反，PN后，Fuhrman III-IV级或pT 3a组织学患者的癌症控制率与RN后相同。泌尿学73：1300-1305，2009年。(C)2009 Elsevier Inc.
OBJECTIVES To assess cancer-specific survival of partial nephrectomy (PN) patients with >= 7-cm lesions or unfavorable pathology (stage T3a or Fuhrman grades III-IV).MATERIAL AND METHODS At 13 participation centers, 4072 partial or radical nephrectomies (RN) were performed for RCC between 1984 and 2001. Of all procedures, 925 (22.7%) were for tumors > 7 cm, 973 (23.9%) had Fuhrman grades III or IV, and 861 (21.1%) had stage pT3a. None had nodal or distant metastases. Matched (age, gender, tumor size, T stage, histologic subtype, and Fuhrman grade [FG]) survival analyses addressed the effect of nephrectomy type (partial vs radical) on cancer-specific mortality.RESULTS Partial nephrectomy for tumors > 7 cm was associated with higher mortality than RN (HR = 5.3; P =.025). No significant cancer-specific survival differences were recorded after PN for FG III-IV (HR = 0.7, P = .5) or for pT3a lesions (HR = 2.5, P = .9).CONCLUSIONS Partial nephrectomy may undermine cancer control in patients with tumors > 7 cm. Conversely, after PN, the same cancer control rates as after RN may be expected in patients with Fuhrman grades III-IV or with pT3a histology. UROLOGY 73: 1300-1305, 2009. (C) 2009 Elsevier Inc.