部分切除术与根治术治疗pT1bN0M0期肾癌的临床疗效对比

目的 比较肾癌部分切除术（partial nephrectomy, PN）和肾癌根治术（radical nephrectomy, RN）治疗pT1bN0M0期肾癌的临床疗效及预后评估，为pT1b期肾癌的治疗选择提供参考。方法 回顾性研究湖北省肿瘤医院从2004年1月至2010年12月诊断为pT1bN0M0的肾癌患者（PN=16例，RN=52例）。比较两组之间的5年总生存率（overall survival, OS），5年无复发生存率（recurrence-free survival, RFS），和5年癌症特异性生存率（cancer-specific survival, CSS）。同时收集了术前和术后肌酐和肾小球滤过率（estimated glomerular filtration rate, eGFR）以评价肾功能的改变。结果 PN与RN的5年OS（90.3% vs. 88.6%, P=0.552）、RFS（90.3% vs. 75.4%, P=0.121）和CSS（90.3% vs. 92.8%, P=0.875）方面差异均无统计学意义。而术后肾功能下降患者所占比例在PN组显著优于RN组（0 vs. 12.6%, P<0.01）。术后一年血肌酐和eGFR水平在RN组中要高于PN组 （0.3±0.6）vs.（0.2±0.1）、（20.1±12.6）vs.（9.8±12.1）]，但是差异无统计学意义（P=0.115, P=0.064）。结论 PN或RN对于pT1bN0M0期肾癌的治疗在预后和安全性方面差异均无统计学意义，PN术后肾功能指标显著优于RN，PN是治疗pT1b期肾癌的一个可行方案。

Clinical Outcomes of pT1bN0M0 Renal Cell Carcinoma: Partial Versus Radical Nephrectomy

Objective To compare the clinical outcomes and prognosis of partial nephrectomy (PN) and radical nephrectomy (RN) on pT1bN0M0 renal cell carcinoma (RCC) patients, and to provide reference for treatment selection on pT1b RCC. Methods We retrospectively analyzed the data of 68 patients (PN=16 cases, RN=52 cases) diagnosed as pT1bN0M0 RCC from January 2004 to December 2010 in Hubei Cancer Hospital. We compared the clinical outcomes including 5-year overall survival (OS), recurrence-free survival (RFS) and cancer-specific survival (CSS) between two groups. We also analyzed renal function by collecting creatinine and estimated glomerular filtration rate(eGFR) before and after the operation. Results The 5-year OS (90.3% vs. 88.6%, P=0.552), RFS (90.3% vs. 75.4%, P=0.121) and CSS (90.3% vs. 92.8%, P=0.875) between PN and RN groups were not significantly different. The number of patients with a decrease of renal function was fewer in the PN group than that in the RN group (0 vs. 12.6%, P<0.01). However, the serum creatinine and GFR one year after surgery was not significantly different between two groups (0.2±0.1) vs. (0.3 ±0.6), P=0.115, (9.8±12.1) vs. (20.1±12.6), P=0.064]. Conclusion There was no significant difference in the clinical outcomes and safety between PN and RN on pT1bN0M0 RCC patients, moreover, postoperative renal function of PN group were better than those of RN group. PN could be an appropriate and safe option for pT1b RCC.