Overall Survival and Development of Stage IV Chronic Kidney Disease in Patients Undergoing Partial and Radical Nephrectomy for Benign Renal Tumors
Overall Survival and Development of Stage IV Chronic Kidney Disease in Patients Undergoing Partial and Radical Nephrectomy for Benign Renal Tumors
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DOI：
10.1016/j.eururo.2012.12.023
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发表时间：
2013-10-01
期刊：
影响因子：
23.4
通讯作者：
Thompson, R. Houston
中科院分区：
文献类型：
--
作者：
Kaushik, Dharam;Kim, Simon P.;Thompson, R. Houston
背景资料：虽然肾部分切除术（PN）与根治性肾切除术（RN）相比，肾细胞癌患者的肾功能得到改善，但其对总生存率（OS）的影响仍存在争议。目的：评价恶性肿瘤不是混杂因素的肾肿块患者接受PN和RN后的OS和肾功能的比较。设计、设置和参与者：使用马约诊所肾切除术登记，我们回顾性地确定了1980年至2008年期间接受PN或RN手术治疗的442例单侧散发性良性肾脏肿块患者。结果测量和统计分析：主要结局指标为OS和新发IV期慢性肾脏病（CKD）的发生率，采用Kaplan-Meier方法确定。考克斯模型被用来测试肾切除术类型与这些outcome.Results和局限性：总体而言，206和236例良性肾肿块手术治疗RN和PN，分别。接受RN的患者年龄较大（中位年龄：67岁vs 64岁; p = 0.02），肿瘤较大（中位大小：5.0 vs 2.7 cm; p < 0.001）。末次随访时仍然存活的患者的中位随访时间为8.3年（范围：0.1-27.9年）。RN组10年和15年时的估计OS（95%置信区间[CI]）率分别为69%（62-76%）和53%（45-62%），PN组分别为80%（73-87%）和74%（65-83%）（p = 0.032）。调整相关协变量后，与接受PN的患者相比，接受RN治疗的患者更有可能死于任何原因（风险比[HR]：1.75; 95% CI，1.08-2.83; p = 0.023）或发展为IV期CKD（HR：4.23; 95% CI，1.80-9.93; p < 0.001）。局限性包括回顾性设计，手术方法的选择偏差，转诊偏见三级医疗facility.Conclusions：我们的数据表明，PN可能会赋予改善肾功能和更好的OS相比，RN排除恶性肿瘤的混杂效应的临床效益。(C)2012年欧洲泌尿外科协会。Elsevier B. V.出版，保留所有权利。
Background: Although partial nephrectomy (PN) has been associated with improved renal function compared with radical nephrectomy (RN) for renal cell carcinoma, the impact on overall survival (OS) remains controversial.Objective: To evaluate comparative OS and renal function in patients following PN and RN for a renal mass where malignancy was not a confounding factor.Design, setting, and participants: Using the Mayo Clinic Nephrectomy Registry, we retrospectively identified 442 patients with unilateral sporadic benign renal masses treated surgically with PN or RN between 1980 and 2008.Outcome measurements and statistical analysis: The primary outcome measures were OS and the incidence of new-onset stage IV chronic kidney disease (CKD), determined using the Kaplan-Meier method. Cox models were used to test the association of nephrectomy type with these outcomes.Results and limitations: Overall, 206 and 236 patients with benign renal masses were surgically treated with RN and PN, respectively. Patients who underwent RN were older (median age: 67 vs 64 yr; p = 0.02) and had larger tumors (median size: 5.0 vs 2.7 cm; p < 0.001). Median follow-up for patients still alive at last follow-up was 8.3 yr (range: 0.1-27.9 yr). Estimated OS (95% confidence interval [CI]) rates at 10 and 15 yr were 69% (62-76%) and 53% (45-62%) for RN compared with 80% (73-87%) and 74% (65-83%) following PN (p = 0.032). After adjusting for covariates of interest, patients treated with RN were significantly more likely to die from any cause (hazard ratio [HR]: 1.75; 95% CI, 1.08-2.83; p = 0.023) or develop stage IV CKD (HR: 4.23; 95% CI, 1.80-9.93; p < 0.001) compared with patients who underwent PN. Limitations include the retrospective design, selection bias for surgical approach, and referral bias to a tertiary care facility.Conclusions: Our data suggest that PN may confer a clinical benefit for improved renal function and better OS compared with RN after excluding the confounding effect of malignancy. (C) 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved.