肾部分切除术治疗囊性肾癌的功能学和肿瘤学结果：单中心回顾性研究

doi:10.19723/j.issn.1671-167X.2024.04.020

摘要/Abstract

摘要：

目的: 分析单中心肾部分切除术治疗囊性肾癌的结果，并将其与监测、流行病学和最终结果(Surveillance, Epidemiology, and End Results, SEER)数据库进行对比，探究术后肾功能和肿瘤学结局。方法: 纳入2010—2023年就诊于北京大学第三医院(Peking University Third Hospital, PUTH)泌尿外科行肾部分切除术的囊性肾癌患者，收集临床资料并统计基线特征。分别采用肾动态显像和加入了中国种族系数的慢性肾脏病流行病学协作组(Chinese Coefficients for Chronic Kidney Disease Epidemiology Collaboration，C-CKD-EPI)公式测定估算肾小球滤过率(estimated glomerular filtration rate, eGFR), 并绘制肾功能的变化曲线，对患者进行随访，记录生存状态。纳入SEER数据库中2000—2020年的囊性肾癌病例，进行倾向性评分匹配(propensity score matching, PSM)以平衡与PUTH患者数据的差异，采用Kaplan-Meier方法描绘PUTH队列和SEER队列的肿瘤特异性生存率(cancer-specific survival, CSS)曲线。结果: PUTH患者队列和SEER数据库中的患者队列分别纳入了38例和385例患者，PSM后各筛选出31例和72例，患者的基线特征仅在肿瘤直径上差异有统计学意义(P=0.042)。PSM后在CSS上差异无统计学意义(P=0.556)，SEER队列的中位随访时间为112.5个月，10年生存率为97.2%，PUTH队列的中位随访时间为57.0个月、10年生存率为100.0%。肾动态显像测定的eGFR与基于肌酐估算的结果差异无统计学意义(P=0.073)；术前、术后短期、术后长期之间的eGFR差异有统计学意义(P＜0.001)，具体为术后短期肾功能下降，术后长期肾功能恢复。结论: 肾部分切除术治疗囊性肾癌是安全可行的，具有较好的肾功能和肿瘤学结局。

关键词: 囊性肾癌, 肾部分切除术, 肿瘤学结局, 肾功能试验

Abstract:

Objective: To investigate the postoperative renal function and oncologic outcomes of cystic renal cell carcinoma with partial nephrectomy, and to compared the single-center data on surgical outcomes with the Surveillance, Epidemiology, and End Results (SEER) database. Methods: This was a retrospective study that included the patients with cystic renal cell carcinoma who underwent partial nephrectomy in the Department of Urology, Peking University Third Hospital (PUTH) from 2010 to 2023. The clinical data and depicting baseline characteristics were collected. Renal dynamic imaging and the Chinese Coefficients for Chronic Kidney Disease Epidemiology Collaboration (C-CKD-EPI) formulae were used to calculate the estimated glomerular filtration rate (eGFR). The renal function curves over time were then plotted, and the patients were followed-up to record their survival status. Cases of cystic renal cell carcinoma in the SEER database between 2000 and 2020 were included, propensity score matching (PSM) was performed to balance the differences between SEER cohort and PUTH cohort, and the cancer-specific survival (CSS) curves for both groups were plotted and statistical differences were calculated by the Kaplan-Meier method. Results: A total of 38 and 385 patients were included in the PUTH cohort and SEER cohort, respectively, and 31 and 72 patients were screened in each cohort after PSM. Of the baseline characteristics, only tumor size (P=0.042) was found to differ statistically between the two groups. There was no statistically significant difference between the two cohorts in terms of CSS after PSM (P=0.556). The median follow-up time in the SEER cohort was 112.5 (65, 152) months and a 10-year survival rate of 97.2%, while the PUTH cohort had a median follow-up of 57.0 (20, 1 172) months and a 10-year survival rate of 100.0%. There was no statistically significant difference between eGFR determined by preoperative renal dynamic imaging and the results of the C-CKD-EPI formulae based on creatinine estimation (P=0.073). There was a statistically significant difference in eGFR among the preoperative, short-term postoperative, and long-term postoperative (P < 0.001), which was characterized by the presence of a decline in renal function in the short-term postoperative period and the recovery of renal function in the long-term period. Conclusion: Partial nephrectomy for cystic renal cell carcinoma is safe and feasible with favorable renal function and oncologic outcomes.

Key words: Cystic renal cell carcinoma, Partial nephrectomy, Oncological outcome, Kidney function tests

中图分类号:

R737.11

舒帆,郝一昌,张展奕,邓绍晖,张洪宪,刘磊,王国良,田晓军,赵磊,马潞林,张树栋. 肾部分切除术治疗囊性肾癌的功能学和肿瘤学结果：单中心回顾性研究[J]. 北京大学学报（医学版）, 2024, 56(4): 667-672.

Fan SHU,Yichang HAO,Zhanyi ZHANG,Shaohui DENG,Hongxian ZHANG,Lei LIU,Guoliang WANG,Xiaojun TIAN,Lei ZHAO,Lulin MA,Shudong ZHANG. Functional and oncologic outcomes of partial nephrectomy for cystic renal cell carcinoma: A single-center retrospective study[J]. Journal of Peking University (Health Sciences), 2024, 56(4): 667-672.

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参考文献 17

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Variables	Total (n=38)
Stay time/d	6 (5, 8)
BMI/(kg/m²)	24.93±4.42
Extubation time/d	5 (3, 6)
HGB change/(g/L)	-20.42±11.38
Albumin/(g/dL)	43.66±3.69
eGFR-trouble side/(mL/min)	45.32±12.02
OT/min	144.00 (123.25, 199.75)
WIT/min	21.50 (15.25, 26.00)
EBL/mL	22.50 (12.50, 100.00)
Hypertension
No	31 (81.6)
Yes	7 (18.4)
Diabetes
No	35 (92.1)
Yes	3 (7.9)
Surgical history
No	27 (71.1)
Yes	11 (28.9)
Surgical option
Laparoscope	33 (86.8)
Robot-assisted	4 (10.5)
Open	1 (2.6)
Approach
Retroperitoneal	23 (60.5)
Transperitoneal	15 (39.5)
Anteroposterior location
Anterior	20 (52.6)
Posterior	13 (34.2)
Neither	5 (13.2)
Longitudinal location
Upper pole	11 (28.9)
Middle pole	10 (26.3)
Lower pole	17 (44.7)
Perirenal fat invasion
No	34 (89.5)
Yes	4 (10.5)
ASA grade
1	21 (55.3)
2	15 (39.5)
3	2 (5.3)
Complication
No	36 (94.7)
Yes	2 (5.3)
Adjuvant therapy
No	32 (84.2)
Yes	6 (15.8)

Variables	Before PSM			After PSM
Variables	SEER cohort (n=385)	PUTH cohort (n=38)	P value	SEER cohort (n=72)	PUTH cohort (n=31)	P value
Age/years	56.60±12.39	48.24±13.55	＜0.001	50.26±12.14	51.55±11.41	0.617
Tumor size/cm	28.71±18.93	50.26±23.52	＜0.001	37.19±21.57	46.87±22.70	0.042
Gender			0.358			0.794
Male	218 (56.6)	25 (65.8)		50 (69.4)	20 (64.5)
Female	167 (43.4)	13 (34.2)		22 (30.6)	11 (35.5)
Laterality			0.629			0.533
Left	183 (47.5)	21 (55.3)		33 (45.8)	17 (54.8)
Right	202 (52.5)	17 (44.7)		39 (54.2)	14 (45.2)
T stage			＜0.001			0.126
1a	309 (80.3)	16 (42.1)		48 (66.7)	15 (48.4)
1b	51 (13.2)	8 (21.1)		15 (20.8)	6 (19.4)
2a	11 (2.9)	10 (26.3)		5 (6.9)	6 (19.4)
2b	2 (0.5)	0 (0)		1 (1.4)	0 (0)
3a	12 (3.1)	4 (10.5)		3 (4.2)	4 (12.9)
N stage			0.555			0.434
0	373 (96.9)	38 (100.0)		68 (94.4)	31 (100.0)
x	12 (3.1)	0 (0)		4 (5.6)	0 (0)
M stage			0.006			0.252
0	383 (99.5)	37 (97.4)		71 (98.6)	30 (96.8)
1	0 (0)	1 (2.6)		0 (0)	1 (3.2)
x	2 (0.5)	0 (0)		1 (1.4)	0 (0)

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