【摘要翻译】所有T1期肾肿瘤行肾部分切除术的安全性和有效性：国际多中心的经验

[文题]SAFETY AND EFFICACY OF PARTIAL NEPHRECTOMY FOR ALL T1 TUMORS BASED ON AN INTERNATIONAL MULTICENTER EXPERIENCE.
所有T1期肾肿瘤行肾部分切除术的安全性和有效性：国际多中心的经验
[来源]Journal of Urology.
[年、卷、期、页]2004. 171(6, Part 1 of 2):2181-2185
[作者]PATARD, JEAN-JACQUES; SHVARTS, OLEG; LAM, JOHN S.; PANTUCK, ALLAN J.; KIM, HYUNG L.; FICARRA, VINCENZO; CINDOLO, LUCA; HAN, KEN-RYU; DE LA TAILLE, ALEXANDRE; TOSTAIN, JACQUES; ARTIBANI, WALTER; ABBOU, CLAUDE C.; LOBEL, BERNARD; CHOPIN, DOMINIQUE K.; FIGLIN, ROBERT A.; MULDERS, PETER F. A.; BELLDEGRUN, ARIE S.
[原文摘要]
Purpose: We compared cancer specific survival of patients undergoing partial and radical nephrectomies for T1N0M0 renal tumors according to tumor size in a large multicenter series.
Materials and Methods: A retrospective analysis of 1,454 patients undergoing partial or radical nephrectomy for T1N0M0 renal tumors from 7 international academic centers was performed. Data were obtained for each patient including TNM stage (determined according to the 2002 TNM criteria), tumor size, type of surgery (partial versus radical nephrectomy) and cancer specific survival. Recurrence events were recorded when available.
Results: Partial and radical nephrectomies were performed in 379 (26.1%) and 1,075 (73.9%) cases, respectively. Mean followup SD was 62.5 51.8 months. Recurrence data were available on 544 patients. There were no significant differences in local or distant recurrence rates between patients undergoing partial or radical nephrectomy for either T1a (p = 0.6) or T1b tumors (p = 0.5). For patients with T1a tumors, there was no significant difference in the rate of cancer specific deaths between the partial (314) and radical (499) nephrectomy groups (2.2% versus 2.6%, respectively, p = 0.8). For patients with T1b tumors there was also no significant difference in the rate of cancer specific deaths between patients undergoing partial (65) and patients undergoing radical (576) nephrectomy (6.2% versus 9%, respectively, p = 0.6).
Conclusions: Partial nephrectomy is becoming the gold standard for renal tumors less than 4 cm but this treatment is much more controversial for larger T1 tumors. This large multicenter study suggests that it is safe to expand the indications of partial nephrectomy to include patients with T1N0M0 tumors up to 7 cm. However, careful patient selection remains necessary.

[中文译文]
目的：在一项大的多中心系列研究中，对T1M0N0肾肿瘤患者行肾部分切除和根治性肾切除术，按照肿瘤大小比较两种治疗方法患者的肿瘤特异生存情况。
材料与方法：回顾7个国际专科中心1454例因T1N0M0肾肿瘤行肾部分切除和根治性肾切除术的患者。记录每例患者的TNM分期（按照2002年TNM分期标准），肿瘤大小，手术方式（肾部分切除及根治性肾切除术）及肿瘤特异生存情况。复发资料若可用也同时记录。
结果：379例（26.1%）行肾部分切除术，1075例（73.9%）行根治性肾切除术。平均随访62.5±51.8月。544例患者复发资料可用。无论T1a（p=0.6）或T1b（p=0.5）期，行肾部分切除或根治性肾切除术的患者局部或远处复发率均无显著差异。T1a患者行肾部分切除（314）和根治性肾切除术（499）的肿瘤特异死亡率无显著差异（2.2%和2.6%，p=0.8）。T1b患者行肾部分切除（65）和根治行肾切除术（576）的肿瘤特异死亡率也无显著差异（6.2%和9%，p=0.6）。
结论：肾部分切除术正在成为治疗小于4cm的肾肿瘤的金标准，但是对于较大的T1肿瘤，该术式尚存争议。这一大规模的多中心研究提示将肾部分切除术的适应症扩大到包括7cm的T1N0M0肿瘤是安全的。当然，仔细地选择患者仍然是必须的。

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[个人评论]大样本、多中心、对照的研究结果是最令人信服的，结论也是确定的，不过对最后一句话“当然，仔细地选择患者仍然是必须的（However, careful patient selection remains necessary）”不好理解，按照最新的TNM分期，T1a就是小于4cm，T1b就是4-7cm，很明确，还有什么其他可选择的？查原文，作者在讨论里解释，因为是回顾性研究，所以分组并非随机，而是有一定的偏差的。可惜了，结果有一点打折扣了。