单中心评估保留肾单位手术在cT1期Xp11.2易位型肾癌的可行性  

The feasibility of nephron-sparing surgery in patients with Xp11.2 translocation renal cell carcinoma at clinical T1 stage-single-center study

作　　者：马文亮 董翔 卓然 刘宁[1] 李笑弓[1] 张古田[1] 郭宏骞[1] 甘卫东[1] Ma Wenliang;Dong Xiang;Zhuo Ran;Liu Ning;Li Xiaogong;Zhang Gutian;Guo Hongqian;Gan Weidong(Department of Urology,Nanjing Drum Tower Hospital,the affiliated Hospital of Nanjing University Medical School,Drum Tower Clinical Medical School of Nanjing Medical University,Jiangsu 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院泌尿外科,南京医科大学鼓楼临床医学院泌尿外科,江苏210008

出　　处：《中华腔镜泌尿外科杂志（电子版）》2021年第2期97-102,共6页Chinese Journal of Endourology(Electronic Edition)

基　　金：国家自然科学基金面上项目(81572512);南京市科技发展计划项目(201803025)。

摘　　要：目的评估保留肾单位手术(NSS)在cT1期Xp11.2易位型肾癌(Xp11.2 tRCC)的可行性。方法回顾性对比分析2007年1月至2020年8月在南京鼓楼医院确诊的45例cT1期Xp11.2 tRCC和135例cT1期透明细胞肾细胞癌(ccRCC)临床病理资料。结果在Xp11.2 tRCC中c T1a期和c T1b期患者各有13例(52%)和11例(55%)行NSS,而在ccRCC中cT1a期和cT1b期患者各有57例(74%)和48例(82.8%)行NSS。与ccRCC相比,Xp11.2 tRCC瘤体距离肾盂集合系统或肾窦脂肪较近,居于肾脏中央偏内生型生长(均P<0.05)。生存分析显示cT1b期Xp11.2tRCC患者根治性肾切除术(RN)组无进展生存期(PFS)明显优于NSS组(P=0.036),而cT1a期和c T1期患者总体生存期(OS)和PFS差异均无统计学意义(P>0.05)。然而多因素分析显示手术方式不是影响Xp11.2 tRCC患者疾病进展的独立危险因素(P=0.475和P=0.061)。结论cT1a期Xp11.2 tRCC患者行NSS是安全可行的,而cT1b期患者应慎重选择NSS。Objective To assess the feasibility of nephron sparing surgery(NSS)in Xp11.2 translocation renal cell carcinoma(Xp11.2 tRCC)at clinical T1 stage(cT1).Methods The clinicopathological data of both 45 Xp11.2 tRCC patients and 135 clear cell renal cell carcinoma(ccRCC)patients at cT1 stage from Nanjing Drum Tower Hospital between January 2007 and August 2020 were analyzed retrospectively.Results 13 patients(52%)at stage cT1 a and 11 cases(55%)at stage cT1 b underwent NSS in Xp11.2 tRCC while 57 cases(74%)in stage cT1 a and 48 cases(82.8%)in stage cT1 b underwent NSS in ccRCC.Xp11.2 tRCC was more adjacent to the collecting system,renal sinus and central location of kidney,and it tended to show endophytic properties compared with ccRCC(all P<0.05).Survival analysis demonstrated that patients who underwent RN had more favorable progressionfree survival(PFS)than those who underwent NSS(P=0.036),but there was no significant difference in overall survival(OS)and PFS of patients at cT1 a or cT1 stage(P>0.05).However,multivariate analysis did not display that the surgery method was an independent risk factor for PFS of patients with Xp11.2 tRCC(P=0.475 and P=0.061).Conclusion NSS performed on patients with Xp11.2 tRCC at cT1 a stage should be safe and feasible while it should be performed on patients at cT1 b stage with more caution.

关 键 词：肾细胞癌 Xp11.2易位 TFE3 保留肾单位手术 

分 类 号：R737.11[医药卫生—肿瘤]