Objectives: To analyze the long-term survival of patients with localized renal cell carcinoma after partical nephrectomy. Methods: The clinicopathological records and survival follow-up data of 2 046 patients with localized renal cell carcinoma, who were treated with partial nephrectomy from August 2001 to February 2021 in the Department of Urology, Sun Yat-sen University Cancer Center, were retrospectively analyzed. There were 1 402 males and 644 females, aged (M(IQR)) 51 (19) years (range: 6 to 86 years). The primary end point of this study was cancer-specific survival. Survival curves were estimated using the Kaplan-Meier method, and the difference test was performed by Log-rank test. Univariate and multivariate Cox analysis were fitted to determine factors associated with cancer-specific survival. Results: The follow-up time was 49.2 (48.0) months (range: 1 to 229 months), with 1 974 patients surviving and 72 dying. The median cancer-specific survival time has not yet been reached. The 5- and 10-year cancer specific survival rates were 97.0% and 91.2%, respectively. The 10-year cancer-specific survival rates for stage pT1a (n=1 447), pT1b (n=523) and pT2 (n=58) were 95.3%, 81.8%, and 81.7%, respectively. The 10-year cancer-specific survival rates of patients with nuclear grade 1 (n=226), 2 (n=1 244) and 3 to 4 (n=278) were 96.6%, 89.4%, and 85.5%, respectively. There were no significant differences in 5-year cancer-specific survival rates among patients underwent open, laparoscopic, or robotic surgery (96.7% vs. 97.1% vs. 97.5%, P=0.600). Multivariate analysis showed that age≥50 years (HR=3.93, 95%CI: 1.82 to 8.47, P<0.01), T stage (T1b vs. T1a: HR=3.31, 95%CI: 1.83 to 5.99, P<0.01; T2+T3 vs. T1a: HR=2.88, 95%CI: 1.00 to 8.28, P=0.049) and nuclear grade (G3 to 4 vs. G1: HR=2.81, 95%CI: 1.01 to 7.82, P=0.048) were independent prognostic factors of localized renal cell carcinoma after partial nephrectomy. Conclusions: The long-term cancer-specific survival rates of patients with localized renal cancer after partial nephrectomy are satisfactory. The type of operation (open, laparoscopic, or robotic) has no significant effect on survival. However, patients with older age, higher nuclear grade, and higher T stage have a lower cancer-specific survival rate. Grasping surgical indications, attaching importance to preoperative evaluation, perioperative management, and postoperative follow-up, could benefit achieving satisfactory long-term survival.
目的： 探讨局限性肾癌患者肾部分切除术后远期生存情况。 方法： 回顾性分析2001年8月至2021年2月在中山大学肿瘤防治中心接受肾部分切除术的2 046例局限性肾癌患者的临床和病理学资料。男性1 402例，女性644例，诊断年龄［M（IQR）］51（19）岁（范围：6~86岁）。以肿瘤特异性生存为主要研究终点，采用Kaplan-Meier法绘制生存曲线，使用Log-rank检验比较差异。采用单因素和多因素Cox比例风险模型分析与肿瘤特异性生存相关的因素。 结果： 随访时间为49.2（48.0）个月（范围：1~229个月），生存1 974例，死亡72例。中位肿瘤特异性生存期未达到。5年和10年肿瘤特异性生存率分别为97.0%和91.2%。pT1a（1 447例）、pT1b（523例）、pT2期（58例）患者的10年肿瘤特异性生存率分别为95.3%、81.8%、81.7%。病理核分级G1（226例）、G2（1 244例）、G3~4级（278例）患者的10年肿瘤特异性生存率分别为96.6%、89.4%、85.5%。开放、腹腔镜和机器人手术患者的5年肿瘤特异性生存率无差异（96.7%比97.1%比97.5%，P=0.600）。多因素分析结果显示，年龄≥50岁（HR=3.93，95%CI：1.82~8.47，P<0.01）、T分期（T1b期比T1a期：HR=3.31，95%CI：1.83~5.99，P<0.01；T2~3期比T1a期：HR=2.88，95%CI：1.00~8.28，P=0.049）、病理核分级（G3~4级比G1级：HR=2.81，95%CI：1.01~7.82，P=0.048）是肾部分切除术后肾癌患者的独立预后因素。 结论： 局限性肾癌患者行肾部分切除术后远期肿瘤特异性生存率高。手术方式（开放、腹腔镜或机器人）对患者生存无明显影响，但年龄越大、病理核分级越高、T分期越高的患者，远期肿瘤特异性生存率越低。严格把握手术适应证，重视术前评估、围手术期管理和术后随访，有助于取得良好的远期生存。.