Partial nephrectomy for T3aN0M0 renal cell carcinoma: shall we step forward?

ABSTRACT Objectives: To evaluate the prognosis of non-metastatic T3a renal cell carcinoma (RCC) with partial nephrectomy (PN). Patients and Methods: We retrospectively evaluated 125 patients with non-metastatic T3a RCC. Patients undergoing PN and radical nephrectomy (RN) were strictly matched by clinic-pathologic characteristics. Log-rank test and Cox regression model were used for univariate and multivariate analysis. Results: 18 pair patients were matched and the median follow-up was 35.5 (10-86) months. PN patients had a higher postoperative eGFR than RN patients (P=0.034). Cancer-specific survival (CSS) and recurrence-free survival (RFS) did not differ between two groups (P=0.305 and P=0.524). On multivariate analysis, CSS decreased with positive surgical margin and anemia (both P <0.01) and RFS decreased with Furhman grade, positive surgical margin, and anemia (all P<0.01). Conclusions: For patients with non-metastatic pT3a RCC, PN may be a possible option for similar oncology outcomes and better renal function.

摘要
目的：评估肾部分切除术（partial nephrectomy，PN）治疗非转移性T3a期肾细胞癌（renal cell carcinoma，RCC）的预后效果。
患者与方法：回顾性分析125例非转移性T3a期肾细胞癌患者，按临床病理特征严格匹配接受肾部分切除术与根治性肾切除术（radical nephrectomy，RN）的病例。采用对数秩检验（Log-rank test）与Cox回归模型（Cox regression model）分别开展单因素与多因素分析。
结果：最终匹配获得18对患者，中位随访时间为35.5（范围10~86）个月。肾部分切除术组患者术后估算肾小球滤过率（estimated glomerular filtration rate，eGFR）显著高于根治性肾切除术组（P=0.034）。两组患者的癌症特异性生存期（cancer-specific survival，CSS）与无复发生存期（recurrence-free survival，RFS）均无显著统计学差异（P=0.305、P=0.524）。多因素分析结果显示，手术切缘阳性与贫血可显著缩短癌症特异性生存期（均P<0.01）；Furhman分级升高、手术切缘阳性及贫血则与无复发生存期缩短显著相关（均P<0.01）。
结论：对于非转移性pT3a期肾细胞癌患者，肾部分切除术可作为一种可选治疗方案，其肿瘤学疗效与根治性肾切除术相当，且可更好地保留肾功能。