早期肾癌保肾手术切缘大小对患者远期疗效的影响  

Impact of margin size on patients＇ long-term effect after nephron sparing surgery for early localized renal cell carcinoma

作　　者：李泉林[1] 关宏伟[2] 秦杰[1] 姜涛[1] 宋希双[1] 

机构地区：[1]大连医科大学附属第一医院泌尿外科,116011 [2]大连医科大学附属第一医院病理科

出　　处：《中华泌尿外科杂志》2012年第7期489-491,共3页Chinese Journal of Urology

基　　金：辽宁省教育厅高等学校科研基金（202203256）

摘　　要：目的探讨小切缘保肾手术治疗早期肾癌的安全性及有效性。方法回顾性分析1998年1月至2008年12月行保肾手术的325例T1期肾癌患者的临床资料。男241例，女84例。年龄41～77岁，平均65岁。患者均经病理学检查确诊为肾细胞癌，病理分期为T1N0M0。肿瘤直径1．0～4．0cm，平均3．4cm（中位数3．5cm）。G，124例（38．2％），G，186例（57．2％），G，15例（4．6％）。透明细胞癌255例（78．5％），乳头状肾癌40例（12．3％），嫌色细胞癌23例（7．1％），多囊性肾癌7例（2．2％）。对侧肾脏正常。依据切缘大小分为≤5mm组125例，6～9mm组102例及≥10mm组98例。比较各组切缘大小、有无肿瘤残留，观察术后局部复发、远处转移情况及远期生存率。结果325例切缘病理均阴性，3组切缘大小平均值及中位数分别为：≤5mm组2．2mm及2．0mm，6～9mm组6．7mm及6．0mm，≥10mm组11．8mm及12．0mm。3组切缘大小比较差异有统计学意义（P〈0．05）。随访时间≤5mm组15～130个月，平均69个月；6～9mm组17～132个月，平均83个月；≥10mm组60～103个月，平均82个月。≤5mm组1例（0．74％）出现同侧肾脏异位复发，6～9mm组1例（0．98％）出现原位局部复发，2例均经肾癌根治术治愈并无瘤生存38个月和24个月。≥10mm组无局部复发。各组间复发率比较差异无统计学意义（P〉0．05）。3组患者均无远处转移及癌特异性死亡发生。Kaplan—Meier生存分析5年总体生存率分别为≤5mm组99．2％，6～9mm组99．0％，≥10mm组98．0％（LogRank x2=1511，P=0．470）。结论小切缘保肾手术有利于保留更多的功能性肾单位，治疗早期肾癌安全、有效，远期疗效好。Objective To explore the safety and efficacy of small margin in nephron sparing surgery for early localized renal cell carcinoma （ RCC）. Methods A total of 325 cases of RCC with normal contralateral kidney and staged as Tla were retrospectivly studied. According to the margin size, 125 cases were with surgical margin ≤5 mm （group≤5 mm） , 102 cases with margin 6 -9 mm （group 6 -9 mm） and 98 cases with margin 〉 10 mm （group 〉 10 mm）. The margin size and status was pathologically evaluated and clinical results including local recurrence, distant metastasis and overall survival rate were followed up and comparatively analyzed. Results None of the patients had positive surgical margins. The mean and median margin sizes were 2.2 and 2.0 mm for group ≤5 mm, 6.7 and 6.0 mm for group 6 -9 mm and 11.8 and 12.0 mm for group 〉 10 mm. The difference was statistically significant （P = 0. 025 ）. The mean and median follow-up time for all the patients were 79 and 83 months （range 15 - 132 months） , with 69 and 73 months （range, 15- 130 months） for group≤5 mm, 83 and 86 （range, 17- 132 months） for group 6-9 mm and 82 and 82 （range60 - 103 months） for group 〉 10 mm. Three patients in group≤5 mm, 5 in group 6 -9 mm and 2 in group 〉 10 mm died of no-cancer related disease during follow-up. One patient in group ≤ 5 mm （0.74%） experienced ectopic recurrence in the same kidney and one in group 6 -9 mm was detected local recurrence in situ （0.98%）. No distant metastasis was detected in all the patients. The overall 5-year survival rate for patients in groups ≤5 mm, 6 -9 mm and 〉 10 mm were 99.2% , 99.0% and 98.0% , respectively. （ Kaplan-Meier survival analysis, Log Rank, X2 = 1.511, P = 0. 470）. Conclu- sions Small margin in nephron sparing surgery is safe and effective in treating RCC with stage T1a, which provides excellent renal function preservation, favorable long-term progression-free survival rate, and is not associated with an increased risk of local recu

关 键 词：肾细胞癌 治疗 保肾手术 手术切缘 

分 类 号：R737[医药卫生—肿瘤]