肾癌肾部分切除术后局部复发的临床分析  

Clinical analysis of local recurrence of renal cell carcinoma after partial nephrectomy

作　　者：翟官忠 刘泽林 王清华 柯帅 郭佳[1] Zhai Guanzhong;Liu Zelin;Wang Qinghua;Ke Shuai;Guo Jia(Department of Urology,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院泌尿外科,湖北430060

出　　处：《中华腔镜泌尿外科杂志（电子版）》2022年第2期128-132,共5页Chinese Journal of Endourology(Electronic Edition)

基　　金：国家自然科学基金青年基金(81702539)

摘　　要：目的探讨肾癌肾部分切除术后局部复发的临床特点,对比手术及靶向药物治疗的预后。方法回顾性分析2006年1月至2019年12月于武汉大学人民医院泌尿外科行肾癌肾部分切除术875例,术后局部复发的19例肾癌患者病历及随访资料。男10例,女9例;中位年龄55(28~72)岁。患者首次复发中位间隔时间为18(3~54)个月。pT_(1a)期6例,pT_(1b)期12例,T_(2)期1例。FuhrmanⅠ~Ⅱ级5例,Ⅲ级10例,Ⅳ级4例。初次手术入路方式:腹腔镜12例,开放7例。二次治疗方式:手术+靶向药物治疗11例,单纯靶向药物治疗8例。二次手术采用腹腔镜手术3例,开放手术8例;重复肾部分切除2例,根治性肾切除9例。结果PN患者首次复发率为2.2%(19/875),二次手术复发率为36.4%(4/11)。本研究11例二次手术患者中位手术时间215(105~270)min。中位出血量270(100~1800)ml。术后并发症Ⅰ级5例,Ⅱ级3例,治疗后好转。13例患者(68.4%)出现舒尼替尼副反应,调整用药后好转。19例患者中位随访时间24(3~54)个月,失访3例,死亡5例。单纯靶向药物治疗组患者1年无进展生存率为62.5%,手术+靶向药物治疗组为81.9%;两组3年无进展生存率分别为31.2%,40.0%。手术+靶向药物治疗组中位无进展生存期为36个月,长于单纯靶向组18个月,两者总无进展生存期差异无统计学意义,P=0.256。结论肾癌肾部分切除术后局部复发患者可选择靶向或手术治疗,对比单纯靶向治疗,手术+靶向综合治疗方式并未使患者取得明显生存获益,需慎重考虑。Objective To explore the clinical features of local recurrence after partial nephrectomy for renal cancer,and compare the prognosis of surgery and targeted drug therapy.Method The medical records and follow-up data of 19 renal cancer patients who had local recurrence after partial nephrectomy in Renmin Hospital of Wuhan University from January 2006 to December 2019 were analyzed retrospectively.There were 10 males and 9 females,the median age was 55(28-72)years.The median time between patients’first recurrence was 18(3-54)months.There were 6 cases in pT_(1a)stage,12 cases in pT_(1b)stage,1 case in T_(2)stage.5 cases in Fuhrman gradeⅠ-Ⅱ,10 cases in gradeⅢ,and 4 cases in gradeⅣ.Primary surgical approach:12 cases underwent laparoscopy,7 cases open surgery.Secondary treatment:surgery+targeted drug therapy in 11 cases,and only targeted drug therapy in 8 cases.Laparoscopy was performed in 3 cases,open surgery in 8 cases;repeated partial nephrectomy in 2 cases,and radical nephrectomy in 9 cases.Result The recurrence rate of partial nephrectomy was 2.2%(19/875)for the first time and 36.4%(4/11)for the second time.In this study,the median operation time of 11 patients with secondary operations was 215(105-270)minutes.The median bleeding volume was 270(100-1800)ml.Postoperative complications occurred in 5 cases of gradeⅠand 3 cases of gradeⅡ,which improved after treatment.13 patients(68.4%)experienced sunitinib side effects,which were improved after treatment.The median follow-up time of 19 patients was 24(3-54)months,3 cases were lost to follow-up,and 5 cases died.The 1-year progression-free survival rate(PFS)of patients in the targeted drug therapy group was 62.5%,and that in the surgery+targeted drug therapy group was 81.9%;the 3-year progression-free survival rates of the two groups were 31.2%and 40.0%,respectively.The median progression-free survival in the surgery+targeted drug treatment group was 36 months,which was longer than the m PFS of the surgery alone group at 18 months.There was no statisticall

关 键 词：肾癌 肾切除术 复发 靶向药物 随访 

分 类 号：R737.11[医药卫生—肿瘤]