BJU Int:低风险肾细胞癌患者在保留肾单位手术与根治性肾脏切除术后是否应该进行不同的随访?

2021-04-15 AlexYang MedSci原创

最近,有研究人员基于对多中心数据库(RECUR)的回顾性分析,调查了pT1-肾细胞癌(RCC)在部分(PN)或根治性肾切除术(RN)后是否应进行不同的随访。

最近,有研究人员基于对多中心数据库(RECUR)的回顾性分析,调查了pT1-肾细胞癌(RCC)在部分(PN)或根治性肾切除术(RN)后是否应进行不同的随访

研究人员对2006年1月至2011年12月期间10个国家15个中心的3380名非转移性RCC治疗患者进行回顾性研究。对于pT1透明细胞RCC(ccRCC)患者,研究人员根据复发部位比较了RN和PN之间的复发模式。单变量和多变量模型用于评估手术方法与无复发生存(RFS)和癌症特异性死亡率(CSM)之间的关联。

研究人员从数据库中确定1995名低风险患者(pT1,pN0,pNx),其中1055名患者(52.9%)进行了PN手术。在多变量分析中,与较差RFS相关的特征包括肿瘤大小(HR 1.32,95%CI 1.14-1.39,p<0.001)、核级(HR 2.31,95%CI 1.73-3.08,p<0. 001)、肿瘤坏死(HR 1.5,95%CI 1.03-2.3,p=0.037)、血管浸润(HR:2.4,95%CI 1.3-4.4,p=0.005)和阳性手术边缘(HR 4.4,95%CI 2.3-8.5,p<0.001)。CSM的Kaplan-Meier分析显示,PN后复发的患者生存率明显优于RN后复发的患者(P=0.02)。虽然上述风险因素与预后相关,单纯的手术类型并不是RFS和CSM的独立预后变量。局限性包括研究的回顾性。

RCC患者肾切除术后建议的随访策略

最后,研究人员指出,随访方案不应仅仅依赖于分期和手术的类型。一个优化的方案还应该包括已验证的风险因素,而不是单纯的手术类型,还要选择最佳的影像学模式,避免不必要的影像学检查。对于RN后的pT1肿瘤患者,应考虑随访3年以上。另外,研究人员还提出了一种新型随访策略。

原始出处:

Y Abu-Ghanem , T Powles , U Capitanio et al. Should patients with low risk renal cell carcinoma be followed differently after nephron-sparing surgery versus radical nephrectomy? BJU Int. Apr 2021

 

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    2021-04-17 jeanqiuqiu
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    2021-04-16 妮妮阿

    学习

    0

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    2021-04-16 ms3000000449926787

    很好!

    0

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