Partial nephrectomy provides equivalent oncologic outcomes and better renal function preservation than radical nephrectomy for pathological T3a renal cell carcinoma: A meta-analysis

ABSTRACT Purpose: Radical nephrectomy (RN) is the standard surgical type for pathological stage T3a (pT3a) renal cell carcinoma (RCC). Recently, some studies have suggested equivalence between partial nephrectomy (PN) and RN for oncologic control and have shown the benefits of PN for better renal function. We conducted this meta-analysis to assess oncologic outcomes, perioperative outcomes and renal function between two groups among patients with pT3a RCC. Materials and methods: PubMed, Scopus, Web of Science, Science Direct, Ovid MEDLINE, The Cochrane Library, Embase and Google Scholar were searched for eligible articles. The endpoints of the final analysis included overall survival (OS), cancer-specific survival (CSS), recurrence-free survival (RFS), surgical complications, operative time, estimated blood loss (EBL), serum creatinine and estimated glomerular filtration rate (eGFR). Results: Twelve studies of moderate to high quality, including 14.152 patients, were examined. PN showed superiority for renal functional preservation, providing higher eGFR (WMD=12.48mL/min; 95%CI: 10.28 to 14.67; P &lt;0.00001) and lower serum creatinine (WMD=-0.31mg/dL; 95%CI: −0.40 to −0.21; P &lt;0.00001). There were no significant differences between PN and RN regarding operative time, EBL, surgical complications, OS, RFS and CSS. Despite inherent selection bias, most pooled estimates were consistent in sensitivity analysis and subgroup analysis. More positive margins were found in the PN group (RR=2.42; 95%CI: 1.25-4.68; P=0.009). Conclusions: PN may be more suitable for treating pT3a RCC than RN because it provides a similar survival time (OS or RFS) and superior renal function. Nevertheless, this result is still disputed, and more high-quality studies are required.ABSTRACT 研究目的：根治性肾切除术（Radical nephrectomy, RN）是病理分期T3a（pT3a）肾细胞癌（renal cell carcinoma, RCC）的标准手术方式。近年来多项研究提示，部分肾切除术（partial nephrectomy, PN）与根治性肾切除术在肿瘤学控制效果上相当，且部分肾切除术对肾功能的保护更具优势。本项荟萃分析旨在评估pT3a肾细胞癌患者接受两种术式后的肿瘤学结局、围手术期结局及肾功能差异。 材料与方法：检索PubMed、Scopus、Web of Science、Science Direct、Ovid MEDLINE、The Cochrane Library、Embase及Google Scholar数据库，筛选符合纳入标准的相关文献。最终分析的终点指标包括总生存期（overall survival, OS）、癌症特异性生存期（cancer-specific survival, CSS）、无复发生存期（recurrence-free survival, RFS）、手术并发症、手术时长、估计失血量（estimated blood loss, EBL）、血清肌酐及估算肾小球滤过率（estimated glomerular filtration rate, eGFR）。 结果：最终纳入12项中至高质量研究，共包含14152例患者。分析结果显示，部分肾切除术在肾功能保护方面更具优势，其术后估算肾小球滤过率更高（加权均数差WMD=12.48mL/min；95%置信区间CI：10.28~14.67；P<0.00001），血清肌酐水平更低（WMD=-0.31mg/dL；95%CI：−0.40~−0.21；P<0.00001）。两种术式在手术时长、估计失血量、手术并发症、总生存期、无复发生存期及癌症特异性生存期方面均无显著差异。尽管存在固有选择偏倚，但多数合并估计值在敏感性分析及亚组分析中结果一致。部分肾切除术组的切缘阳性率更高（相对风险RR=2.42；95%CI：1.25~4.68；P=0.009）。 结论：相较于根治性肾切除术，部分肾切除术或许更适用于pT3a肾细胞癌的治疗，因其可获得相当的生存期（总生存期或无复发生存期）且肾功能保护更优。不过该结论仍存在争议，尚需更多高质量研究予以验证。