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目的总结对侧肾功能正常的T1b期肾癌患者行肾部分切除术和根治性肾切除术的疗效差异,为临床上T1b期肾癌患者在手术方式的选择上提供循证学证据。方法收集Pubmed/Medline、Cochrane图书馆、Embase、CNKI中国期刊全文数据库、维普数据库和万方数字化期刊群2012年6月30日前国内外公开发表的有关T1b期肾癌患者行肾部分切除术(PN)和根治性肾切除术(RN)疗效比较的临床对照研究文献,对符合要求的文献进行Meta法系统分析。结果按照严格的纳入标准,最终PN和RN疗效和安全性比较的临床对照研究文献共6篇,总共纳入15 740例患者,PN组1 841例,RN组13 926例。两种手术方式术后5年总生存率、5年肿瘤特异性生存率、5年无瘤生存率和肿瘤转移情况的相对危险度分别为1.02(95%CI为0.94～1.12)、1.11(95%CI为1.04～1.18)、0.67(95%CI为0.19～2.40)和0.21(95%CI为0.08～0.51)。结论两种手术方式术后患者5年总的生存率、5年无瘤生存率差别无统计学意义;PN组术后5年肿瘤特异性生存率优于RN组,PN组比RN组术后更容易合并肿瘤转移。因肾部分切除术能最大限度地保存残肾的肾单位和残肾功能,所以对T1b期肾癌行肾部分切除术是一种有效和可靠的治疗方法。但由于存在发表偏倚、选择偏倚的可能,我们期待出现更高质量的研究为以上结论提供更为可靠的证据。
Objective To summarize the curative effect of partial nephrectomy and radical nephrectomy on patients with T1b renal cell carcinoma with normal contralateral renal function, and to provide evidence-based evidence for the choice of surgical approach in patients with T1b renal cell carcinoma. Methods Pubmed / Medline, Cochrane Library, Embase, CNKI Chinese Journal Full-text Database, VIP Database and Wanfang Digital Periodicals were published at home and abroad before June 30, 2012.Patients with T1b stage renal cell carcinoma underwent partial nephrectomy (PN ) And radical nephrectomy (RN) efficacy comparison of clinical control literature, met the requirements of the literature by Meta method of systematic analysis. Results According to the strict inclusion criteria, the final controlled clinical and controlled study comparing the efficacy and safety of PN and RN was 6 in total. A total of 15 740 patients were enrolled, including 1 841 in PN group and 13 926 in RN group. The relative risk of 5-year overall survival, 5-year tumor-specific survival, 5-year disease-free survival and tumor metastasis were 1.02 (95% CI 0.94-1.12) and 1.11 (95 % CI 1.04 to 1.18), 0.67 (95% CI 0.19 to 2.40) and 0.21 (95% CI 0.08 to 0.51). Conclusion The 5-year overall survival rate and 5-year disease-free survival rate were significantly different between the two surgical approaches. The tumor-specific survival rate at 5 years in PN group was better than that in RN group. PN group was significantly lower than RN group Easier to incorporate tumor metastases. Due to partial nephrectomy can maximize the residual renal unit renal function and residual renal function, so the partial nephrectomy T1b renal cell carcinoma is an effective and reliable treatment. However, due to the possibility of publication bias and selection bias, we expect higher quality studies to provide more reliable evidence for the above conclusion.