肾部分切除和根治性肾切除术治疗T<sub>1b</sub>期肾癌疗效和预后比较的Meta分析

doi:10.19558/j.cnki.10-1020/r.2018.05.011

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摘要目的比较T_1b期肾癌行肾部分切除术(PN)和根治性肾切除术(RN)的疗效和预后差异,为临床选择手术方式提供循证依据。方法检索2000年1月1日~2017年6月30日中国生物医学文献数据库(CBMdisc)、中国期刊全文数据库(CNKI)、维普数据库(VIP)、万方数据库、PubMed、荷兰医学文摘数据库(EMBASE)、Web of science等数据库收录的有关T_1b期肾癌患者行PN和RN的疗效和预后的相关文献,按纳入及排除标准筛选文献、提取资料并评价质量。采用Stata 13.0软件进行Meta分析,比较两种手术方式术后的5年肿瘤特异性生存率、总生存率、术后慢性肾脏病(CKD)发生率以及术后肾小球滤过率(GFR)下降变化。结果共纳入文献13篇,共34 908例患者,PN组4 051例,RN组30 857例。PN和RN两种手术方式术后的5年肿瘤特异性生存率HR=1.01,95% CI=0.85~1.20,总生存率HR=0.71,95% CI=0.35~1.42,均差异无统计学意义。PN术后CKD发生率低于RN ,差异有统计学意义(OR=0.38,95% CI=0.28~0.51)。术后GFR下降变化PN低于RN,差异有统计学意义(SMD=-0.46,95% CI=-0.79~-0.14)。结论PN和RN两种手术方式,术后患者5年肿瘤特异性生存率、总体生存率无差异。术后CKD发生率PN低于RN,术后GFR下降PN亦低于RN,两者均差异有统计学意义。PN在保证治疗效果的前提下尽可能多地保留了肾功能,减少了心血管疾病的发生风险,提高了术后生活质量。因此,对T_1b期肾癌,PN是一种安全可靠的治疗方式。

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	姜义鹏
	刘勇
	闫炳霖
	王国栋
	冷红刚

关键词 ： T_1b期肾癌, 肾部分切除术, 根治性肾切除术, 生存率, 肾小球滤过率, Meta分析

Abstract：Objective:To compare the efficacy and prognosis of partial nephrectomy (PN) vs.radical nephrectomy (RN) for T_1b renal carcinoma. Methods:The relative English and Chinese databases such as China biology medicinedisc (CBMdisc), China national knowledge infrastructure (CNKI), VIP database (VIP), WanFang, Pubmed, excerpta medica database (EMBASE), Web of science on studies comparing PN and RN for T_1b renal carcinoma between January 1, 2000 and June 30, 2017 were searched. Stata 13.0 software was used to compare the 5-year cancer specific survival (CSS) and overall survival (OS), the incidence of postoperative chronic kidney disease (CKD) and the postoperative glomerular filtration rate (GFR) decline between PN and RN. Results:Thirteen papers were included in the literature, with a total of 34 908 patients, 4 051 of PN group, and 30 857 of RN group. There was no significant difference between the PN group and RN group regarding the 5-year CSS and OS (P>0.05). The incidence of CKD after PN was lower than RN, and the difference was statistically significant (OR=0.38, 95% CI=0.28-0.51). The decrease of GFR in PN group was lower than in RN group, and the difference was statistically significant (SMD=-0.46, 95% CI=-0.79--0.14). Conclusions:There were no differences in the 5-year CSS and OS of the patients between PN group and RN group. But the incidence of postoperative CKD and decrease of GFR in PN group were both lower than RN group. PN may be a kind of safe and reliable treatment for T_1b renal carcinoma.

Key words： T_1b renal carcinoma partial nephrectomy radical nephrectomy survival rate glomerular filtration rate meta-analysis

收稿日期: 2018-03-20

ZTFLH:

R737.11

通讯作者: 刘勇,lanbing97@163.com

引用本文:

姜义鹏, 刘勇, 闫炳霖, 王国栋, 冷红刚. 肾部分切除和根治性肾切除术治疗T_1b期肾癌疗效和预后比较的Meta分析[J]. 微创泌尿外科杂志, 2018, 7(5): 331-337.
Jiang Yipeng, Liu Yong, Yan Binglin, Wang Guodong, Leng Honggang. A meta-analysis for comparison of partial nephrectomy vs. radical nephrectomy in patients with t_1b renal cell carcinoma. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2018, 7(5): 331-337.

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http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/abstract/abstract1448.shtml 或 http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/Y2018/V7/I5/331

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