The feasibility of nephron-sparing surgery in patients with Xp11.2 translocation renal cell carcinoma at clinical T1 stage-single-center study

doi:10.3877/cma.j.issn.1674-3253.2021.02.003

Abstract

Abstract:

Objective

To assess the feasibility of nephron sparing surgery (NSS) in Xp11.2 translocation renal cell carcinoma (Xp11.2 tRCC) at clinical T1 stage (cT1).

Methods

The clinicopathological data of both 45 Xp11.2 tRCC patients and 135 clear cell renal cell carcinoma (ccRCC) patients at cT1 stage from Nanjing Drum Tower Hospital between January 2007 and August 2020 were analyzed retrospectively.

Results

13 patients (52%) at stage cT1a and 11 cases (55%) at stage cT1b underwent NSS in Xp11.2 tRCC while 57 cases (74%) in stage cT1a and 48 cases (82.8%) in stage cT1b underwent NSS in ccRCC. Xp11.2 tRCC was more adjacent to the collecting system, renal sinus and central location of kidney, and it tended to show endophytic properties compared with ccRCC (all P<0.05). Survival analysis demonstrated that patients who underwent RN had more favorable progression-free survival (PFS) than those who underwent NSS (P=0.036), but there was no significant difference in overall survival (OS) and PFS of patients at cT1a or cT1 stage (P>0.05). However, multivariate analysis did not display that the surgery method was an independent risk factor for PFS of patients with Xp11.2 tRCC (P=0.475 and P=0.061).

Conclusion

NSS performed on patients with Xp11.2 tRCC at cT1a stage should be safe and feasible while it should be performed on patients at cT1b stage with more caution.

Key words: Renal cell carcinoma, Xp11.2 translocation, TFE3, Nephron-sparing surgery

Wenliang Ma, Xiang Dong, Ran Zhuo, Ning Liu, Xiaogong Li, Gutian Zhang, Hongqian Guo, Weidong Gan. The feasibility of nephron-sparing surgery in patients with Xp11.2 translocation renal cell carcinoma at clinical T1 stage-single-center study[J]. Chinese Journal of Endourology(Electronic Edition), 2021, 15(02): 97-102.

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References 20

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组别	例数	年龄[岁，(±s)]	性别(例)		侧别(例)		肿瘤分级(例)		肿瘤最大径[cm，(±s)]	核分级(例)		手术方式(例)
组别	例数	年龄[岁，(±s)]	男	女	左	右	cT1a	cT1b	肿瘤最大径[cm，(±s)]	Ⅰ-Ⅱ级	Ⅲ-Ⅳ级	保留肾单位	根治术
Xp11.2易位型肾癌	45	32±15	17	28	21	24	25	20	4.2±1.2	15	30	24	21
透明细胞肾细胞癌	135	62±10	89	46	84	51	77	58	4.7±1.3	93	42	105	30
P值		<0.001	0.001		0.067		0.862		0.064	<0.001		0.002

组别	例数	年龄[岁，(±s)]	性别(例)		侧别(例)		肿瘤分级(例)		肿瘤最大径[cm，(±s)]	核分级(例)		手术方式(例)
组别	例数	年龄[岁，(±s)]	男	女	左	右	cT1a	cT1b	肿瘤最大径[cm，(±s)]	Ⅰ-Ⅱ级	Ⅲ-Ⅳ级	保留肾单位	根治术
Xp11.2易位型肾癌	45	32±15	17	28	21	24	25	20	4.2±1.2	15	30	24	21
透明细胞肾细胞癌	135	62±10	89	46	84	51	77	58	4.7±1.3	93	42	105	30
P值		<0.001	0.001		0.067		0.862		0.064	<0.001		0.002

解剖结构		cT1a			cT1b
解剖结构		Xp11.2易位型肾癌(n=25)	透明细胞肾细胞癌(n=90)	P值	Xp11.2易位型肾癌(n=20)	透明细胞肾细胞癌(n=45)	P值
肿瘤直径[cm，(±s)]		3.36±0.51	3.42±0.68	0.704	5.32±0.92	5.41±0.64	0.726
肿瘤外生状态[例，(%)]				0.442			0.048
	≥50%	11(20.0%)	48(53.4%)		7(35.0%)	28(62.3%)
	< 50%	5(44.0%)	21(23.3%)		5(25.0%)	11(24.4%)
	完全内生型	9(36.0%)	21(23.3%)		8(40.0%)	6(13.3%)
与肾集合系统或肾窦距离[例，(%)]				0.012			0.004
	≥7 mm	3(12.0%)	27(30.0%)		2(10.0%)	20(44.4%)
	≥4 mm且<7 mm	7(28.0%)	30(33.3%)		4(20.0%)	12(26.7%)
	< 4 mm	15(60.0%)	33(36.7%)		14(70.0%)	13(28.9%)
肾脏腹侧或背侧[例，(%)]				0.384			0.096
	腹侧	13(52.0%)	38(42.2%)		12(60.0%)	17(37.8%)
	背侧	12(48.0%)	52(57.8%)		8(40.0%)	28(62.2%)
与肾脏极线相对位置[例，(%)]				0.250			0.512
	完全上极或下极	5(20.0%)	14(15.6%)		3(11.8%)	13(28.1%)
	跨越上或下极线（≤50%）	4(16.0%)	30(33.3%)		6(35.3%)	13(19.5%)
	跨越上或下极线（>50%）或中轴线	16(64.0%)	46(51.1%)		11(52.9%)	19 (52.3%)
总RNEAL评分（±s)		7.75±2.11	6.32±1.27	0.016	8.86±1.46	7.08±1.54	0.018

解剖结构		cT1a			cT1b
解剖结构		Xp11.2易位型肾癌(n=25)	透明细胞肾细胞癌(n=90)	P值	Xp11.2易位型肾癌(n=20)	透明细胞肾细胞癌(n=45)	P值
肿瘤直径[cm，(±s)]		3.36±0.51	3.42±0.68	0.704	5.32±0.92	5.41±0.64	0.726
肿瘤外生状态[例，(%)]				0.442			0.048
	≥50%	11(20.0%)	48(53.4%)		7(35.0%)	28(62.3%)
	< 50%	5(44.0%)	21(23.3%)		5(25.0%)	11(24.4%)
	完全内生型	9(36.0%)	21(23.3%)		8(40.0%)	6(13.3%)
与肾集合系统或肾窦距离[例，(%)]				0.012			0.004
	≥7 mm	3(12.0%)	27(30.0%)		2(10.0%)	20(44.4%)
	≥4 mm且<7 mm	7(28.0%)	30(33.3%)		4(20.0%)	12(26.7%)
	< 4 mm	15(60.0%)	33(36.7%)		14(70.0%)	13(28.9%)
肾脏腹侧或背侧[例，(%)]				0.384			0.096
	腹侧	13(52.0%)	38(42.2%)		12(60.0%)	17(37.8%)
	背侧	12(48.0%)	52(57.8%)		8(40.0%)	28(62.2%)
与肾脏极线相对位置[例，(%)]				0.250			0.512
	完全上极或下极	5(20.0%)	14(15.6%)		3(11.8%)	13(28.1%)
	跨越上或下极线（≤50%）	4(16.0%)	30(33.3%)		6(35.3%)	13(19.5%)
	跨越上或下极线（>50%）或中轴线	16(64.0%)	46(51.1%)		11(52.9%)	19 (52.3%)
总RNEAL评分（±s)		7.75±2.11	6.32±1.27	0.016	8.86±1.46	7.08±1.54	0.018

变量	组别	cT1期	单因素		多因素
变量	组别	cT1期	HR（95%CI）	P值	HR（95%CI）	P值
年龄	均值为界	cT1a	1.024（0.973～1.077）	0.362	1.083（0.993～1.180）	0.072
年龄	均值为界	cT1b	1.042（0.955～1.136）	0.355	1.045（0.938～1.165）	0.427
手术切缘	阳性与阴性	cT1a	1.265（0.151～10.585）	0.828	0.736（0.045～12.095）	0.830
手术切缘	阳性与阴性	cT1b	0.608（0.063～5.912）	0.668	0.663（0.059～7.466）	0.740
核分级	Ⅰ-Ⅱ级与Ⅲ-Ⅳ级	cT1a	4.485（0.973～20.659）	0.054	13.187（1.643～105.849）	0.015
核分级	Ⅰ-Ⅱ级与Ⅲ-Ⅳ级	cT1b	9.192（0.551～153.224）	0.122	9.932（0.228～432.638）	0.233
坏死或肉瘤样变	有与无	cT1a	0.602（0.072～5.021）	0.639	0.926（0.069～12.359）	0.954
坏死或肉瘤样变	有与无	cT1b	12.718（1.111～145.635）	0.041	12.802（0.897～182.727）	0.060
手术方式	保留肾单位与根治术	cT1a	0.968（0.209～4.475）	0.966	2.279（0.238～21.850）	0.475
手术方式	保留肾单位与根治术	cT1b	0.014（0.001～44.083）	0.298	0.086（0.007～1.122）	0.061

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