Partial vs Radical Nephrectomy for T1-T2 Renal Masses in the Elderly: Comparison of Complications, Renal Function, and Oncologic Outcomes.
Partial vs Radical Nephrectomy for T1-T2 Renal Masses in the Elderly: Comparison of Complications, Renal Function, and Oncologic Outcomes.
复制标题
老年人中T1-T2肾脏肿块的部分与自由基肾切除术：并发症，肾功能和肿瘤结局的比较。
DOI：
10.1016/j.urology.2016.10.047
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发表时间：
2017-02
期刊：
影响因子：
2.1
通讯作者：
Pierorazio PM
中科院分区：
文献类型：
--
作者：
An JY;Ball MW;Gorin MA;Hong JJ;Johnson MH;Pavlovich CP;Allaf ME;Pierorazio PM
比较65岁及以上患者肾部分切除术（PN）和根治性肾切除术（RN）的结局。我们的机构肾脏肿块登记处查询了65岁及以上的患者，孤立的cT 1-T2肾肿块切除PN或RN。比较两组的临床病理特征和围手术期结局。分析通过估计肾小球滤过率（eGFR）的变化和eGFR< 45 mL/min/1.73 m2的自由度测量的肾功能结局。分析了总生存期和癌症特异性生存期的多变量考克斯比例风险模型。总体而言，787例患者符合入选标准。其中，437例（55.5%）接受PN，350例（44.5%）接受RN。中位随访时间为36个月。PN队列中的患者更年轻（中位年龄70.3岁对71.9岁，P < .001），美国麻醉医师协会评分较低（2.6 vs 2.8，P = .001），较小的肿瘤肾细胞癌的发生率较低（76.7%比87.4%，P <0.001）。PN组和RN组的围手术期结局相似，并发症也相似（37.8% vs 38.9%）。末次随访时，PN组eGFR的估计变化小于RN组（6.4 vs 19.7，P <0.001）。两种治疗方式的总生存率和癌症特异性生存率相同。由于PN的肾功能受益已实现多年，且该手术的历史并发症发生率高于RN，因此一些疑似老年患者可能从RN中获益多于PN。然而，这些数据表明，老年患者不会受到伤害，并且可能从PN中获益。年龄本身不应成为保留肾单位手术的禁忌症。
To compare outcomes of partial nephrectomy (PN) and radical nephrectomy (RN) in patients 65 years and older. Our institutional renal mass registry was queried for patients 65 and older with solitary cT1–T2 renal mass resected by PN or RN. Clinicopathologic features and perioperative outcomes were compared between groups. Renal function outcomes measured by change in estimated glomerular filtration rate (eGFR) and freedom from eGFR< 45 mL/min/1.73 m2 were analyzed. Multivariate Cox proportional hazard models for overall survival and cancer-specific survival were analyzed. Overall, 787 patients met inclusion criteria. Of these, 437 (55.5%) underwent PN and 350 (44.5%) underwent RN. Median follow-up was 36 months. Patients in the PN cohort were younger (median age 70.3 years vs 71.9 years, P < .001), had lower American Society of Anesthesiologists scores (2.6 vs 2.8, P = .001), smaller tumors (tumor diameter 2.8 cm vs 5.0 cm, P < .001), and lower proportion of renal cell carcinoma (76.7% vs 87.4%, P < .001). Perioperative outcomes were similar between PN and RN groups as were complications (37.8% vs 38.9%). Estimated change in eGFR was less in PN vs RN (6.4 vs 19.7, P < .001) at last follow-up. Overall survival and cancer-specific survival were equivalent between modalities. Because the renal functional benefit of PN is realized over many years and the procedure has a higher historical complication rate than RN, some suspected elderly patients might benefit more from RN over PN. However, these data suggest that elderly patients are not harmed and may potentially benefit from PN. Age alone should not be a contraindication to nephron-sparing surgery.