T1b腎細胞癌病患接受部分腎切除之腫瘤控制及功能保存成效
廖博崎、洪晟鈞、張瓈文、王樹吉、李健儀、陳卷書、楊晨洸、歐宴泉、賀昊中、裘坤元
台中榮總 外科部 泌尿科；中山醫學大學；國立暨南大學 應用化學系；弘光科技大學 護理系；台中童綜合醫院
Oncological and functional efficacy of partial nephrectomy for T1b renal cell carcinoma
Po-Chi Liao, Sheng-Chun Hung1, 2, Li-Wen Chang1, Shian-Shiang Wang1, 2, 3, Jian-Ri Li1, 2, 4, Chuan-Shu Chen1, 2, Chun-Kuang Yang1, Chen-Li Cheng1, 2, Yen-Chuan Ou1, 2, 5, Hao-Chung Ho1, Kun-Yuan Chiu1, 3
1 Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan,2 Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, 3 Department of Applied Chemistry, National Chi Nan University, Nantou, 4 Department of Medicine and Nursing, Hungkuang University, Taichung, Taiwan Taiwan, 5 Department of Urology, Tung's Taichung MetroHarbor Hospital, Taichung, Taiwan
Purpose:
To evaluate oncological and functional efficacy of partial nephrectomy for cT1b renal cell carcinoma (RCC)
Materials and methods:
We retrospective review the 150 patients with cT1 RCC received partial nephrectomy from 2002 to 2016. End point evaluation is assessed by disease free survival, overall survival, stage III and stage IV chronic kidney disease (CKD). Regression models were assessed to determine the risk factors of CKD after operation.
Results:
90 patients with cT1a tumor and 60 patients with cT1b tumor were assessed. Tumor diameter was large in cT1b group (cT1a 2.92±0.98 cm vs. cT1b 5.03±1.46cm, p=0.028) and higher RENAL nephrometry score but no statistical significance (cT1a 6.88±1.81 vs. cT1b 8.31±1.61, p=0.163). There is no difference of disease free survival, overall survival, stage III and stage IV CKD among the two groups. In cox-regression models, preoperative eGFR is the independent risk factor for stage III (HR=0.937 95% CI 0.930-0.961, p=0.000) and stage IV CKD (HR=0.929 95% CI 0.870-0.992, p=0.027) in multivariate analysis.
Conclusions:
In compare with cT1a RCC, patients with cT1b RCC could achieve compatible oncological and functional outcome. Preoperative eGFR is the independent predictors for develop stage III and IV CKD after partial nephrectomy.