BJU Int：保留肾单位手术治疗肾癌效果佳

　　研究发现，保留肾单位手术在治疗临床T1a期肾癌方面比消融术更有效。作者提到，虽然绝对差异较小且临床意义不大，但与消融术相比，NSS术后的特种疾病存活率高达2倍，Jared Whitson和同事们使用监测、流行病学和最终结果(SEER) 癌症注册，进行了一项群体性队列研究，比较了NSS和消融术治疗T1a期肾细胞癌的有效性。在1998年到2007年间，SEER数据库总共收纳了8818名此类患者。其中，7704人实施NSS，1114人实施消融术。NSS 组的随访中位期是2.8年，消融术组是1.6年。总共716名患者在随访时死亡，15%死于RCC，NSS组91人(1.2%)，消融术组19人(1.7%)。

　　在单变量分析中，实施消融术患者发生肾癌死亡的可能性更大，比NSS高2.6倍。调整多种影响因子后，风险比（HR）下降到1.9。影响RCC死亡率的多种因素是年龄、性别、婚姻状况和肿瘤大小。

　　作者说，值得注意的是，特种疾病存活率（5年）的预测概率在两个治疗组相似，NSS组为98.3%，消融术组为96.6%。这提示治疗效果只有在预期寿命长的患者中才能体现出不同。

　　进一步分析不同类型消融治疗的差异。 与NSS相比，分型不明确的消融发生死亡的风险最大(HR=2.5)，冷冻消融最小(HR=1.5)，射频消融在两者之间(HR=2.2)。

　　Whitson等的结论：我们的发现提示，对于群体性队列中的T1a期肾癌而言，予以NSS治疗的患者其特种疾病存活率至少比实施消融术患者高2倍。所以，应将NSS视为标准护理。

与肾癌相关的拓展阅读：

• 保留肾单位手术治疗肾癌效果佳
• 舒尼替尼一线治疗晚期肾癌的中国证据
• 阿西替尼被欧盟委员会批准用于治疗晚期肾癌
• Nat Med：新研究显示IMA901肾癌疫苗优于化疗
• Nat Med:德国研究发现一种肾癌疫苗安全有效
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Population-based comparative effectiveness of nephron-sparing surgery vs ablation for small renal masses

OBJECTIVE

To determine, in a population-based cohort, if disease-specific survival (DSS) was equivalent in patients undergoing ablation vs nephron-sparing surgery (NSS) for clinical stage T1a renal cell carcinoma (RCC).

PATIENTS AND METHODS

A retrospective cohort study was performed using patients from the Surveillance, Epidemiology and End Results cancer registry with RCC < 4 cm and no evidence of distant metastases, who underwent ablation or NSS.

Kaplan–Meier and Cox regression analyses were performed to determine if treatment type was independently associated with DSS.

RESULTS

Between 1998 and 2007, a total of 8818 incident cases of RCC were treated with either NSS (7704) or ablation (1114).

The median (interquartile range) follow-up was 2.8 (1.2–4.7) years in the NSS group and 1.6 (0.7–2.9) years in the ablation group, although 10% of each cohort were followed up beyond 5 years.

After multivariable adjustment, ablation was associated with a twofold greater risk of kidney cancer death than NSS (hazard ratio 1.9, 95% confidence interval 1.1–3.3, P= 0.02).

Age, gender, marital status and tumour size were also significantly associated with outcome.

The predicted probability of DSS at 5 years was 98.3% with NSS and 96.6% with ablation.

CONCLUSION

After controlling for age, gender, marital status and tumour size, the typical patient presenting with clinical stage T1a RCC, who undergoes ablation rather than NSS, has a twofold increase in the risk of kidney cancer death; however, at 5 years the absolute difference is small, and may only be realized by patients with long life expectancies.