山东大学学报（医学版） ›› 2015, Vol. 53 ›› Issue (9): 65-70.doi: 10.6040/j.issn.1671-7554.0.2014.830
苏静1, 薛娇美1, 孙菲菲1, 郭兆新2, 程翔宇2, 孟力维2, 刘照旭2
SU Jing1, XUE Jiaomei1, SUN Feifei1, GUO Zhaoxin2, CHENG Xiangyu2, MENG Liwei2, LIU Zhaoxu2
摘要： 目的 比较肾单位保留术(NSS)和肾癌根治术(RN)治疗对侧肾功能正常的T1b期原发性肾癌患者预后结局。方法 计算机检索PubMed、Elsevier ScienceDirect、Web of Science、Co-chrane Library、中国期刊全文数据库(CNKI)、中国生物医学文献数据库、中文科技期刊数据库和万方数据库,查找所有比较NSS和 RN 治疗T1b期肾癌的队列研究,检索时限均为建库至 2014年 9月 30 日。同时手工检索纳入文献的参考文献。按纳入排除标准筛选文献、提取资料和评价质量后,采用Stata12.0软件进行Meta 分析。结果 共纳入11项研究,23939例患者。Meta分析结果显示,NSS和RN治疗T1b期肾癌的5年[RR=1.05, 95%CI(0.98, 1.13)]、7年[RR=1.02, 95%CI(0.94, 1.10)]、10年[RR=1.30, 95%CI(0.96, 1.77)]的生存率差异无统计学意义;NSS的5年肿瘤特异生存率高于RN[RR=1.11, 95%CI(1.06, 1.16)]; NSS的5年肿瘤特异死亡率低于RN[RR=0.70, 95%CI(0.55, 0.90)]; NSS的肿瘤转移率低于RN[RR=0.38, 95%CI(0.22, 0.66)]。结论 对于纳入本研究的患者,NSS和RN比较,患者的5、7、10年生存率相似,但NSS 5年肿瘤特异生存率高,5年肿瘤特异死亡率、转移率低。
中图分类号:
| [1] Gupta K, Miller JD, Li JZ, et al. Epidemiologic and socioeconomic burden of metastatic renal cell carcinoma (mRCC):a literature review[J]. Cancer Treat Rev, 2008, 34(3):193-205. [2] Silverman SG, Israel GM, Herts BR, et al. Management of the incidental renal mass[J]. Radiology, 2008, 249(1):16-31. [3] Milonas D, Skulcius G, Baltrimavicius R, et al. Comparison of long-term results after nephron-sparing surgery and radical nephrectomy in treating 4-to 7-cm renal cell carcinoma[J]. Medicina (Kaunas), 2013, 49(5):223-228. [4] 王权, 周文生. 小肾癌的治疗策略[J]. 中华全科医学, 2010, 8(12):1590-1592. [5] Tomaszewski JJ, Smaldone MC, Uzzo RG, et al. Is radical nephrectomy a legitimate therapeutic option in patients with renal masses amenable to nephron-sparing surgery?[J]. BJU Int, 2015, 115(3):357-363. [6] Antonelli A, Cozzoli A, Nicllai M, et al. Nephron-sparing surgery versus radical nephrectomy in the treatment of intracapsular renal cell carcinoma up to 7cm[J]. Eur Urol, 2008, 53(4):803-809. [7] Wells G, Shea B, O'Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses [EB/OL]. [2012-06-15]. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. [8] Badalato GM, Kates M, Wisnivesky JP, et al. Survival after partial and radical nephrectomy for the treatment of stage T1bN0M0 renal cell carcinoma (RCC) in the USA:a propensity scoring approach[J]. BJU Int, 2012, 109(10):1457-1462. [9] Crépel M, Jelares C, Perrotte P, et al. Nephron-sparing surgery is equally effective to radical nephrectomy for T1BN0M0 renal cell carcinoma:a population-based assessment[J]. Urology, 2010, 75(2):271-275. [10] Iizuka J, Kondo T, Hashimoto Y, et al. Similar functional outcomes after partial nephrectomy for clinical T1b and T1a renal cell carcinoma[J]. Int J Urol, 2012, 19(11):980-986. [11] Kim JM, Song PH, Kim HT, et al. Comparison of partial and radical nephrectomy for pT1b renal cell carcinoma[J]. Korean J Urol, 2010, 51(9):596-600. [12] Leibovich BC, Blute M, Cheville JC, et al. Nephron sparing surgery for appropriately selected renal cell carcinoma between 4 and 7 cm results in outcome similar to radical nephrectomy[J]. J Urol, 2004, 171(3):1066-1070. [13] Meskawi M, Becker A, Bianchi M, et al. Partial and radical nephrectomy provide comparable long-term cancer control for T1b renal cell carcinoma[J]. Int J Urol, 2014, 21(2):122-128. [14] Patard JJ, Shvarts O, Lam JS, et al. Safety and efficacy of partial nephrectomy for all T1 tumors based on an international multicenter experience[J]. J Urol, 2004, 171(6):2181-2185. [15] Thompson RH, Siddiqui S, Lohse CM, et al. Partial versus radical nephrectomy for 4 to 7 cm renal cortical tumors[J]. J Urol, 2009, 182(6):2601-2606. [16] Weight CJ, Larson BT, Gao T, et al. Elective partial nephrectomy in patients with clinical T1b renal tumors is associated with improved overall survival[J]. Urology, 2010, 76(3):631-637. [17] 胡波, 王涛, 刘继红,等. 保留肾单位手术和肾癌根治手术治疗局限性肾癌疗效比较的Meta分析[J]. 临床泌尿外科杂志, 2011, 26(5):324-327. HU Bo, WANG Tao, LIU Jihong, et al. Comparison of nephron-sparing surgery vs.radical phrectomy in patients with localized renal cell carcinoma:a Meta-analysis[J]. Journal of clinical Urology, 2011, 26(5):324-327. [18] Kim SP, Murad MH, Thompson RH, et al. Comparative effectiveness for survival and renal function of partial and radical nephrectomy for localized renal tumors:a systematic review and Meta-analysis[J]. J Urol, 2012,188(1):51-57. [19] Lucas SM, Stern JM, Adibi M, et al. Renal function outcomes in patients treated for renal masses smaller than 4 cm by ablative and extirpative techniques[J]. J Urol, 2008, 179(1):75-79. [20] Lane BR, Russo P, Uzzo RG, et al. Comparison of cold and warm ischemia during partial nephrectomy in 660 solitary kidneys reveals predominant role of nonmodifiable factors in determining ultimate renal function[J]. J Urol, 2011, 185(2):421-427. [21] Miller DC, Schonlau M, Litwin MS, et al. Renal and cardiovascular morbidity after partial or radical nephrectomy[J]. Cancer, 2008, 112(3):511-520. [22] 郑殿宇, 王勤章, 丁国富, 等. 肾部分切除术和肾癌根治术治疗T1b期肾癌疗效比较的Meta分析[J]. 现代泌尿外科杂志, 2013, 18(4):342-346. ZHENG Dianyu, WANG Qinzhang, DING Guofu, et al. Comparison of partial vs radical nephrectomy in patients with T1b renal cell carcinoma:a Meta-analysis[J]. Journal of Modern Urology, 2013, 18(4):342-346 |
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