伴远处转移T1期肾癌原发灶行减瘤性肾部分切除术与减瘤性根治性肾切除术的生存分析

  目的  探索和比较原发灶行减瘤性肾部分切除术（cytoreductive partial nephrectomy，cPN）与减瘤性根治性肾切除术（cytoreductive radical nephrectomy，cRN）对于伴远处转移的T₁期肾癌患者的生存获益。  方法  回顾性分析SEER（Surveillance, Epidemiology, and End Results）数据库中934例符合纳入标准的伴远处转移的T₁期肾癌病例，根据手术方式分为cPN组和cRN组。评估934例患者中与cRN与cPN有关的差异因素，再通过倾向性评分匹配消除混杂后，对得到的141对病例进行生存分析，利用Kaplan-Meier生存分析比较配对前后cPN组和cRN组之间的总生存（OS）、肿瘤特异性生存（cancer specific survival ，CSS）的差异。利用Cox多因素风险评估模型评估匹配后OS和CSS的影响因素。  结果  匹配前，142（15.2%）例患者行cPN，792（84.8%）例病例行cRN，cPN组患者OS和CSS均高于cRN组患者（log rank检验， P<0.01），T_1b期患者接受cPN的可能性比T_1a期患者小。匹配后，Kaplan-Meier分析发现cPN组的OS和CSS比cRN组更高（log rank检验，P<0.01），多因素Cox回归分析发现选择行cRN是导致OS及CSS不佳的独立危险因素。  结论  对于伴远处转移的T₁期肾癌患者，cPN的预后生存优于cRN。

Cytoreductive Partial Nephrectomy versus Cytoreductive Radical Nephrectomy for Locally T1 Stage Metastatic Renal Rell Carcinoma (mRCC)

  Objective   To explore whether cytoreductive partial nephrectomy (cPN) or cytoreductive radical nephrectomy (cRN), is more beneficial for patients with locally T₁ stage metastatic renal cell carcinoma (mRCC).   Methods   We retrospectively collected the data ofthe patients with locally T₁ stage mRCC (n=934) from the Surveillance, Epidemiology, and End Results (SEER) database. Logistic regression was conducted to identify the determinants of cPN. Propensity-score match (PSM) was used to diminish the confounder. Kaplan-Meier survival analyses was performed and multivariable Cox proportional hazards model was used to evaluate the effect of cPN and cRN on overall survival (OS) and cancer specific survival (CSS).   Results   Among the 934 patients, 142 (15.2%) received cPN and 792 (84.8%) received cRN. Before PSM, both OS and CSS in cPN group were better in Kaplan-Meier analysis (log rank test, each P< 0.01). In a survival analysis of propensity-score matched 141 pairs of patients, cPN was still associated with improved OS and CSS compared with cRN (log rank test, each P< 0.01). After PSM, the 2-year OS were 61.7% and 74.4%, and 5-year OS were 35.6% and 59.2% in the cRN and cPN cohorts respectively. Cox proportional hazards model confirmed cPN the independent risk factor of both OS and CSS.   Conclusion   For mRCC patients with locally T₁ stage, cPN may gain an OS and CSS benefit compared with cRN.