Partial Nephrectomy Versus Radical Nephrectomy for Clinical T1b and T2 Renal Tumors: A Systematic Review and Meta-analysis of Comparative Studies

医学 肾切除术 荟萃分析 优势比 置信区间 子群分析 科克伦图书馆 泌尿科 围手术期 内科学 外科
作者
Maria Carmen Mir,Ithaar Derweesh,Francesco Porpiglia,Homayoun Zargar,Alexandre Mottrie,Riccardo Autorino
出处
期刊:European Urology [Elsevier BV]
卷期号:71 (4): 606-617 被引量:385
标识
DOI:10.1016/j.eururo.2016.08.060
摘要

Partial nephrectomy (PN) is the reference standard of management for a cT1a renal mass. However, its role in the management of larger tumors (cT1b and cT2) is still under scrutiny. To conduct a meta-analysis assessing functional, oncologic, and perioperative outcomes of PN and radical nephrectomy (RN) in the specific case of larger renal tumors (≥cT1b). The primary endpoint was an overall analysis of cT1b and cT2 masses. The secondary endpoint was a sensitivity analysis for cT2 only. A systematic literature review was performed up to December 2015 using multiple search engines to identify eligible comparative studies. A formal meta-analysis was performed for studies comparing PN to RN for both cT1b and cT2 tumors. In addition, a sensitivity analysis including the subgroup of studies comparing PN to RN for cT2 only was conducted. Pooled estimates were calculated using a fixed-effects model if no significant heterogeneity was identified; alternatively, a random-effects model was used when significant heterogeneity was detected. For continuous outcomes, the weighted mean difference (WMD) was used as summary measure. For binary variables, the odds ratio (OR) or risk ratio (RR) was calculated with 95% confidence interval (CI). Statistical analyses were performed using Review Manager 5 (Cochrane Collaboration, Oxford, UK). Overall, 21 case-control studies including 11 204 patients (RN 8620; PN 2584) were deemed eligible and included in the analysis. Patients undergoing PN were younger (WMD −2.3 yr; p < 0.001) and had smaller masses (WMD −0.65 cm; p < 0.001). Lower estimated blood loss was found for RN (WMD 102.6 ml; p < 0.001). There was a higher likelihood of postoperative complications for PN (RR 1.74, 95% CI 1.34–2.2; p < 0.001). Pathology revealed a higher rate of malignant histology for the RN group (RR 0.97; p = 0.02). PN was associated with better postoperative renal function, as shown by higher postoperative estimated glomerular filtration rate (eGFR; WMD 12.4 ml/min; p < 0.001), lower likelihood of postoperative onset of chronic kidney disease (RR 0.36; p < 0.001), and lower decline in eGFR (WMD −8.6 ml/min; p < 0.001). The PN group had a lower likelihood of tumor recurrence (OR 0.6; p < 0.001), cancer-specific mortality (OR 0.58; p = 0.001), and all-cause mortality (OR 0.67; p = 0.005). Four studies compared PN (n = 212) to RN (n = 1792) in the specific case of T2 tumors (>7 cm). In this subset of patients, the estimated blood loss was higher for PN (WMD 107.6 ml; p < 0.001), as was the likelihood of complications (RR 2.0; p < 0.001). Both the recurrence rate (RR 0.61; p = 0.004) and cancer-specific mortality (RR 0.65; p = 0.03) were lower for PN. PN is a viable treatment option for larger renal tumors, as it offers acceptable surgical morbidity, equivalent cancer control, and better preservation of renal function, with potential for better long-term survival. For T2 tumors, PN use should be more selective, and specific patient and tumor factors should be considered. Further investigation, ideally in a prospective randomized fashion, is warranted to better define the role of PN in this challenging clinical scenario. We performed a cumulative analysis of the literature to determine the best treatment option in cases of localized kidney tumor of higher clinical stage (T1b and T2, as based on preoperative imaging). Our findings suggest that removing only the tumor and saving the kidney might be an effective treatment modality in terms of cancer control, with the advantage of preserving the kidney function. However, a higher risk of perioperative complications should be taken into account when facing larger tumors (clinical stage T2) with kidney-sparing surgery.
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
PDF的下载单位、IP信息已删除 (2025-6-4)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
雪霁梅香完成签到,获得积分10
刚刚
汉堡包应助典雅的俊驰采纳,获得10
1秒前
1秒前
mitty发布了新的文献求助10
1秒前
人生如梦应助清脆的灵煌采纳,获得10
2秒前
2秒前
2秒前
2秒前
2秒前
long0809完成签到,获得积分10
2秒前
城中慕楚寒完成签到,获得积分10
2秒前
英俊不凡发布了新的文献求助10
2秒前
3秒前
不敢装睡发布了新的文献求助10
3秒前
guoweismmu发布了新的文献求助10
3秒前
4秒前
4秒前
mfxj发布了新的文献求助80
4秒前
深情安青应助寸愿采纳,获得10
4秒前
cbuno关注了科研通微信公众号
5秒前
110011发布了新的文献求助20
6秒前
6秒前
lxy发布了新的文献求助10
6秒前
01发布了新的文献求助10
6秒前
123完成签到,获得积分10
7秒前
山茶发布了新的文献求助10
8秒前
无花果应助东堂采纳,获得10
8秒前
澡雪发布了新的文献求助10
8秒前
缪甲烷完成签到,获得积分10
9秒前
myth发布了新的文献求助10
9秒前
9秒前
123发布了新的文献求助20
9秒前
朴实雨竹完成签到,获得积分10
10秒前
小钱全完成签到,获得积分10
10秒前
可爱的函函应助冷酷寒安采纳,获得10
11秒前
11秒前
今后应助洪世贤采纳,获得10
11秒前
快点毕业发布了新的文献求助30
11秒前
Dddd关注了科研通微信公众号
12秒前
利好完成签到 ,获得积分10
12秒前
高分求助中
Picture Books with Same-sex Parented Families: Unintentional Censorship 700
ACSM’s Guidelines for Exercise Testing and Prescription, 12th edition 500
Nucleophilic substitution in azasydnone-modified dinitroanisoles 500
不知道标题是什么 500
Indomethacinのヒトにおける経皮吸収 400
Phylogenetic study of the order Polydesmida (Myriapoda: Diplopoda) 370
Effective Learning and Mental Wellbeing 300
热门求助领域 (近24小时)
化学 材料科学 医学 生物 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 遗传学 基因 物理化学 催化作用 冶金 细胞生物学 免疫学
热门帖子
关注 科研通微信公众号,转发送积分 3974797
求助须知:如何正确求助?哪些是违规求助? 3519250
关于积分的说明 11197623
捐赠科研通 3255405
什么是DOI,文献DOI怎么找? 1797769
邀请新用户注册赠送积分活动 877156
科研通“疑难数据库(出版商)”最低求助积分说明 806202