| Part 1 Hospital-based epidemiological survey of renal cancer and survival analysisObjective:1. To retrospectively analyze epidemiological characteristics of renal cancer in a single center of General Hospital of People’s Liberation Army;2. To investigate survival rate of patients with renal cancer, scree factors affecting the prognosis of renal cancer, and explore predictors;3. To investigate influence of surgical intervention (surgical strategies, surgical methods and surgical approached) on the prognosis of renal cancerMethods:The clinical characteristics of patients undergoing surgical treatment for renal cancer in the Department of Urology of General Hospital of People’s Liberation Army between January 2008 and September 2016 were collected, including general information,imaging findings, surgical findings, pathological findings, and follow up results, and the epidemiological characteristics of renal cancer were analyzed. Logistic and Cox regression analyses were employed for survival analysis and analysis of factors affecting the prognosis of renal cancer. ROC was used to evaluate the clinical significance of prognostic factors of renal cancer.Results and conclusion1. A single center based database of renal cancer was successfully established according to the 4167 patients treated in the General Hospital of People’s Liberation Army. Among these patients, 3836 finished follow up, with a median time of follow up of 40 months (range: 2-99 months); 331 were lost to follow up, with a follow up lost rate of of 8.11%.2. Epidemiological characteristics of renal cancer: the male to female ratio was 2.6 : 1;the majority of patients were aged 40-65 years; the left to right renal cancer ratio was 0.98 : 1; 2.2% of patients had bilateral renal cancer. 79.3% of patients were asymptomatic at initial diagnosis, and 20.7% had symptoms at initial diagnosis. The most common pathological type of renal cancer was clear cell carcinoma which accounted for 88.07%. The mean diameter of renal cancer was 4.19±2.61 cm. 91.7% of patients received minimally invasive surgery; NSS and RN were performed in 40.7%and 59.2% of patients, respectively. Laparoscopy, robot-assisted surgery and open surgery were performed in 78.6%, 13.1% and 8.3% of patients, respectively.Retroperitoneal and transperitoneal approaches were employed in 83.1% and 16.9% of patients, respectively.3. The 1-year, 3-year and 5-year overall survival rates were 98.12%, 94.80% and 91.99%, respectively. The 1-year, 3-year and 5-year tumor-specific survival rates were 98.61%, 96.15% and 94.59%, respectively. The 1-year, 3-year and 5-year disease-free survival rates were 96.35%, 92.82% and 90.66%, respectively.4. Logistic and Cox regression analyses showed age, surgical strategies, tumor diameter, MN stage and Fuhrman stage were positively related to the tumor-specific death and tumor-specific adverse events. NSS was a protective factor of prognosis of renal cancer, but RN was a risk factor. The risk for tumor-specific death in RN was 3.2 times that in NSS, The risk for tumor-specific adverse events (cancer metastasis,recurrence and death) in RN was 3.5 times that in NSS.5. Surgical methods (laparoscopy,robot-assisted surgery and open surgery) and surgical approaches (Retroperitoneal and transperitoneal approaches) had no significant influence on the tumor-specific survival rate.6. ROC analysis showed the cut-off tumor diameter that was used to predict the tumor-specific morality was 5.9, which had the specificity and sensitivity of 84.2% and 71.5%, respectively; the cut-off tumor diameter that was used to predict the tumor-specific adverse events was 5.0 cm which had the specificity and sensitivity of 80.8% and 67.9%, respectively.Part 2 Minimally invasive surgery of complex renal cancersObjective:1. To compare clinical efficacy of robot-assisted surgery vs laparoscopy in the treatment of renal cancer;2. To summary the clinical characteristics of complex renal cancer(bilateral renal cancer, renal cancer of renal hilum, completely endophytic renal cancer, and renal cancer at stage T1b and T2a), and to compare clinical efficacy between RPN and LPN in the surgical treatment of CRC.Methods:On the basis of above renal cancer database, the complex renal cancers were screened.The data collection, collation and analysis were performed according to the methods mentioned in Part 1 besides tendency matching analysis (the caliper was 60% of standard deviation of tendency index)Results and conclusion1. Tendency matching analysis showed robot-assisted surgery was able to shorten the warm ischemia time, operation time and hospital stay as compared to laparoscopy, but there were no significant differences in the intra-operative blood loss, creatinine and time to food intake between them.2. For the bilateral renal cancer, renal cancer of renal hilum, completely endophytic renal cancer, and renal cancers at stage T1b and T2a, 1) the prevalence was 2.2%(n=85), 1.9% (n=80), 0.6% (n=26), 24.4% (n=1018) and 6.2% (n=257), respectively; 2)the male to female ratio was 6.1 : 1, 1.1 : 1, 2.3 : 1, 3.2 : 1, and 2.1 : 1, respectively; 3)the median age of disease onset was 52.8 years (range: 25-70 years), 51.3 years (range:9-72 years), 50 years (26-76 years), 51.4 years (range: 23-79 years) and 54.8 years(range: 17-81 years), respectively; 4) clear cell carcinoma as a major pathological type accounted for 80%, 85%, 88.6%, 77.4% and 80.9%, respectively; 5) the tumor-specific survival rate was 88.3%, 97.5%, 96.2%, 97.3% and 89.5%, respectively.3. The NSS of above complex renal cancers could be performed by RPN and LPN,with a positive margin rate of 3.5%, 0%, 3.8%, 0.8% and 0%, respectively, after NSS.As compared to LPN, RPN was able to significantly shorten the warm ischemia time,reduce the incidence of intra-operative adverse events and shorten hospital stay without increasing tumor-specific adverse events.4. The tumor diameter of <4 cm as a gold standard for NSS in cases of local renal cancer was still conservative. NSS is preferred for the complex renal cancers mentioned in this study if the technique is available. |
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