T1腎細胞癌病患接受部分腎切除手術之預後：臺中榮民總醫院經驗
張瓈文 洪晟鈞 王賢祥 李建儀 楊晨洸 陳卷書 賀昊中 洪啟峰 程千里 楊啟瑞 歐宴泉 賀昊中 裘坤元＊
臺中榮民總醫院外科部泌尿外科
Outcome of patients with T1 renal cell carcinoma received partial nephrectomy: VGHTC experience
Li-Wen Chang, Sheng-Chun Hung, Shian-Shiang Wang, Jian-Ri Li, Cheng-Kuang Yang, Chuan-Shu Chen, Hao-Chung Ho, Chi-Feng Hung, Chen-Li Cheng, Chi-Rei Yang, Yen-Chuan Ou, Kun-Yuan Chiu＊
Divisions of Urology, Department of Surgery, Taichung Veterans General Hospital, Taiwan
Purpose: To evaluation the renal function and oncology outcome of patient with T1 RCC received partial nephrectomy in Taichung Veteran General Hospital.
Materials and methods: From 2002 to 2016, 150 patients with T1 RCC received partial nephrectomy at Taichung Veteran General Hospital. Patients characteristics such as HTN, DM, creatinine and eGFR were recorded. RENAL score was also evaluated via contrast enhanced CT or MRI. Peri- and post-operative parameters such as EBL, ischemic time and surgical margin was also compared. Recurrence free survival was defined as free from local recurrence or distance metastasis. Overall survival was defined as free from all cause death. Post operation renal function was compared with the end point as CKD 3 and CKD 4.
Results: Among the all patients, 90 were pathology T1a and 60 were pathology T1b. Preoperative characteristics such as age, BMI, hypertension and DM appears no difference among the two groups. Tumor sized was greater in the T1b group, with 5.03 cm to 2.92 cm (p=0.028). Although RENAL score is higher in T1b group, there is no significance among the two group (8.31 vs 6.88, p = 0.163). EBL was higher 480 vs 275.33, p=0.004) and hospital stay was longer in the T1b group (8.65 vs 6.97, p=0.007), which may reflect the complexity of surgery.
In consideration of oncology outcome, there’s no difference in recurrence free survival and overall survival among the two group. The incidence of CKD 3 and CKD 4 appears no difference in Kaplain Mier survival curve among the two group.
Age, HTN, DM, preop creatinine and eGFR appear significance as the risk factors of CKD 3 in uni-variant cox regression model. However, after adjust the all variants in multi-variant model, preoperative eGFR appears to be the most independent risk factor for CKD 3 (HR=0.937 95% CI 0.930-0.961, p=0.000). Althogh, preoperative eGFR is the independent risk factor for stage 4 CKD in uni- and multi- variant model (HR=0.929 95% CI 0.870-0.992, p=0.027).
Conclusions: Among the limited study population, partial nephrectomy appears suitable for T1b RCC in selective cases, with comparable oncology outcome, acceptable surgical complexity and good renal function preservation. Preoperative eGFR is the independent risk factor for stage 3 and stage 4 CKD after partial nephrectomy.