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

陈泽清; 杨文锦; 陈子毅; 郭宏骞; 纪长威

doi:10.13201/j.issn.1001-1420.2024.11.003

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

- 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
基金项目:
国家自然科学基金面上项目(No: 82172777)

详细信息

通讯作者: 纪长威，E-mail：jichangwei@nju.edu.cn

中图分类号: R737.11

收稿日期: 2024-08-22

刊出日期: 2024-11-06

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

- 1.
  Department of Urology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China
- 2.
  Institute of Urology Nanjing University
- 3.
  Department of Urology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine

More Information

Corresponding author: JI Changwei, E-mail: jichangwei@nju.edu.cn

Received Date: 22 August 2024

Publish Date: 06 November 2024

摘要

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/m²。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 m²，RN组患者术前中位eGFR为100.1(85.1，108.7) mL/min/1.73 m²。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 m²，RN组患者术后中位eGFR为63.2(54.1，71.4) mL/min/1.73 m²。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。
- 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
Abstract: 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/m². 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 m² in NSS group patients and 100.1(85.1, 108.7) mL/min/1.73 m² 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 m² in NSS group patients and 63.2(54.1, 71.4) mL/min/1.73 m² 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 better than that of RN patients.
- papillary renal cell carcinoma /
- robot-assisted laparoscopic surgery /
- nephron sparing surgery /
- prognostic analysis

HTML全文

表 1 2组患者临床基本资料比较例(%)，X±S，M(Q₁，Q₃)

项目	NSS组(97例)	RN组(22例)	P值
性别			0.570
男	76(78.4)	16(72.7)
女	21(21.6)	6(27.3)
年龄/岁	57.6±10.8	56.8±15.7	0.829
BMI/(kg/m²)	24.4±2.4	25.2±2.5	0.427
术前eGFR/(mL/min/1.73 m²)	103.7(85.4，119.4)	84.3(64.5，99.7)	0.437

下载: 导出CSV

表 2 2组患者术后资料比较例(%)，M(Q₁，Q₃)

项目	NSS组(97例)	RN组(22例)	P值
手术入路			0.004
经腹	57(58.8)	20(90.9)
经腰	40(41.2)	2(9.1)
手术时间/min	140.0(117.5，172.5)	160.0(120.0，182.5)	0.174
术中出血/mL	50(50，100)	100(50，100)	0.321
二次手术			0.035
是	0(0)	1(4.5)
否	97(100.0)	21(95.5)
术后输血			0.041
是	3(3.1)	3(13.6)
否	94(96.9)	19(86.4)
术后eGFR/(mL/min/1.73 m²)	90.3(69.9，104.1)	63.2(54.1，71.4)	< 0.001
肿瘤最大径/cm	3.70(2.50，5.15)	5.50(4.08，7.25)	< 0.001
病理分期			< 0.001
T1a	63(64.9)	5(22.7)
T1b	28(28.9)	8(36.4)
T2	2(2.1)	4(18.2)
T3	3(3.1)	4(18.2)
T4	1(1.0)	1(4.5)

下载: 导出CSV

参考文献(14)

[1]	Hu X, Wang YH, Shao YX, et al. Radical versus partial nephrectomy for T1 non-clear cell renal cell carcinoma[J]. Eur J Surg Oncol, 2023, 49(8): 1519-1523. doi: 10.1016/j.ejso.2023.03.212
[2]	Liu YJ, Houldsworth J, Emmadi R, et al. Assessing genomic copy number alterations as best practice for renal cell neoplasia: an evidence-based review from the cancer genomics consortium workgroup[J]. Cancer Genet, 2020, 244: 40-54. doi: 10.1016/j.cancergen.2020.04.004
[3]	Ren W, Gao X, Zhang X, et al. Prognostic factors for the survival of patients with papillary renal cell carcinoma after surgical management[J]. Clin Transl Oncol, 2020, 22(5): 725-733. doi: 10.1007/s12094-019-02181-0
[4]	Moch H, Amin MB, Berney DM, et al. The 2022 World Health Organization classification of tumours of the urinary system and male genital organs-part A: renal, penile, and testicular tumours[J]. Eur Urol, 2022, 82(5): 458-468. doi: 10.1016/j.eururo.2022.06.016
[5]	周露婷, 杨晓群, 王朝夫. 第五版WHO肾脏肿瘤新分类主要变化解读[J]. 临床与实验病理学杂志, 2022, 38(12): 1409-1413.
[6]	Ljungberg B, Albiges L, Abu-Ghanem Y, et al. European association of urology guidelines on renal cell carcinoma: the 2022 update[J]. Eur Urol, 2022, 82(4): 399-410. doi: 10.1016/j.eururo.2022.03.006
[7]	van Poppel H, Da Pozzo L, Albrecht W, et al. A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma[J]. Eur Urol, 2011, 59(4): 543-552. doi: 10.1016/j.eururo.2010.12.013
[8]	MacLennan S, Imamura M, Lapitan MC, et al. Systematic review of oncological outcomes following surgical management of localised renal cancer[J]. Eur Urol, 2012, 61(5): 972-993. doi: 10.1016/j.eururo.2012.02.039
[9]	Steffens S, Janssen M, Roos FC, et al. Incidence and long-term prognosis of papillary compared to clear cell renal cell carcinoma: a multicentre study[J]. Eur J Cancer, 2012, 48(15): 2347-2352. doi: 10.1016/j.ejca.2012.05.002
[10]	Zucchi A, Novara G, Costantini E, et al. Prognostic factors in a large multi-institutional series of papillary renal cell carcinoma[J]. BJU Int, 2012, 109(8): 1140-1146. doi: 10.1111/j.1464-410X.2011.10517.x
[11]	冯圣佳, 沈凯, 沈黎辉, 等. 机器人辅助与腹腔镜肾部分切除术治疗cT2a期肾癌的安全性和可行性比较分析[J]. 临床泌尿外科杂志, 2024, 39(8): 684-688. https://lcmw.whuhzzs.com/article/doi/10.13201/j.issn.1001-1420.2024.08.006
[12]	Satkunasivam R, Tsai S, Syan S, et al. Robotic unclamped "minimal-margin" partial nephrectomy: ongoing refinement of the anatomic zero-ischemia concept[J]. Eur Urol, 2015, 68(4): 705-712. doi: 10.1016/j.eururo.2015.04.044
[13]	Touijer K, Jacqmin D, Kavoussi LR, et al. The expanding role of partial nephrectomy: a critical analysis of indications, results, and complications[J]. Eur Urol, 2010, 57(2): 214-222. doi: 10.1016/j.eururo.2009.10.019
[14]	Lu Q, Zhao XZ, Zhang S, et al. Robot-assisted simple enucleation versus standard robot-assisted partial nephrectomy for low-or intermediate-complexity, clinical T1 renal tumors: a randomized controlled noninferiority trial[J]. Eur Urol Oncol, 2024, 7(2): 275-281. doi: 10.1016/j.euo.2023.07.019