乳头状肾细胞癌机器人辅助腹腔镜下保留肾单位手术的长期随访和预后研究  

Long-term follow-up and prognosis of robot-assisted laparoscopic nephron-sparing surgery for papillary renal cell carcinoma

作　　者：陈泽清 杨文锦 陈子毅 郭宏骞[1,2,3] 纪长威 CHEN Zeqing;YANG Wenjin;CHEN Ziyi;GUO Hongqian;JI Changwei(Department of Urology,Nanjing Drum Tower Hospital,Affiliated Hospital of Medical School,Nanjing University,Nanjing,210008,China;Institute of Urology Nanjing University;Department of Urology,Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine)

机构地区：[1]南京大学医学院附属鼓楼医院泌尿外科,南京210008 [2]南京大学泌尿外科研究所 [3]南京中医药大学鼓楼临床医学院泌尿外科

出　　处：《临床泌尿外科杂志》2024年第11期950-953,959,共5页Journal of Clinical Urology

基　　金：国家自然科学基金面上项目(No:82172777)。

摘　　要：目的:探讨机器人辅助腹腔镜下保留肾单位手术(nephron-sparing surgery,NSS)对乳头状肾细胞癌(papillary renal cell carcinoma,PRCC)患者的长期随访和预后的影响。方法:回顾性分析2014年12月—2023年10月在南京鼓楼医院行机器人辅助腹腔镜手术的119例PRCC患者的临床资料。其中男92例,女27例,平均年龄(57.5±11.8)岁,平均体重指数(24.56±2.40)kg/m^(2)。行NSS患者97例(NSS组),行根治性肾切除术(radical nephrectomy,RN)患者22例(RN组)。NSS组患者术前中位估算肾小球滤过率(eGFR)为103.7(85.4,119.4)mL/min/1.73 m^(2),RN组患者术前中位eGFR为100.1(85.1,108.7)mL/min/1.73 m^(2)。术后长期规律随访患者99例,详细记录患者的复发、转移情况以及总生存率(overall survival,OS)、无病生存率(disease-free survival,DFS)。结果:119例患者手术均顺利完成,无中转开放手术。中位手术时间为140(120,180)min,中位术中出血量为100(50,120)mL,肿瘤平均最大径为(4.31±2.16)cm。NSS组患者术后中位eGFR为90.3(69.9,104.1)mL/min/1.73 m^(2),RN组患者术后中位eGFR为63.2(54.1,71.4)mL/min/1.73 m^(2)。与RN组患者比较,NSS组患者术前、术后eGFR变化差异无统计学意义。生存分析显示,手术方式是影响患者生存的独立因素,NSS的长期随访eGFR优于RN。术后随访超过5年的患者29例,其中死亡3例、复发2例、转移1例。RN组患者死亡2例(1例为多发转移患者)。结论:PRCC患者行机器人辅助腹腔镜下NSS与RN生存率相当,NSS患者随访肾功能恢复优于RN患者。Objective To investigate the effect of robot-assisted laparoscopic nephron-sparing surgery(NSS) on long-term follow-up and prognosis of patients with papillary renal cell carcinoma(PRCC).Methods The clinical data of 119 PRCC patients who underwent robot-assisted laparoscopic surgery in Nanjing Drum Tower Hospital from December 2014 to October 2023 were retrospectively analyzed. There were 92 males and 27 females. Their average age was (57.5±11.8)years, and the average body mass index was (24.56±2.40) kg/m^(2). Ninety-seven patients underwent NSS and 22 patients underwent radical nephrectomy(RN). Preoperative estimated glomerular filtration rate(eGFR) was 103.7(85.4, 119.4) mL/min/1.73 m^(2) in NSS group patients and 100.1(85.1, 108.7) mL/min/1.73 m^(2) in RN group patients. Ninety-nine patients were followed up regularly for a long time after surgery, and the recurrence, metastasis, overall survival(OS), and disease-free survival(DFS) rates of the patients were recorded in detail.Results All 119 patients of operation were successfully completed without conversion to open surgery. The operation time was 140(120, 180) min, and intraoperative bleeding was 100(50, 120) mL. The maximum diameter of the tumor was (4.31±2.16) cm. Postoperative eGFR was 90.3(69.9, 104.1) mL/min/1.73 m^(2) in NSS group patients and 63.2(54.1, 71.4) mL/min/1.73 m^(2) in RN group patients. Compared with RN group patients, there was no statistically significant difference in eGFR changes before and after surgery in NSS group patients. Survival analysis showed that surgical approach was an independent factor affecting patient survival, and eGFR of NSS group was superior to RN group after long-term follow-up. Twenty-nine patients were followed up for more than 5 years. Three of them died, 2 relapsed, and 1 metastasized. Among them, two RN group patients died (one patient with multiple metastases).Conclusion Robot-assisted NSS for patients with PRCC was associated with survival comparable to RN, but renal function of NSS patients recovered be

关 键 词：乳头状肾细胞癌 机器人辅助腹腔镜手术 保留肾单位手术 预后分析 

分 类 号：R737.11[医药卫生—肿瘤]