| Background: With the development of ultrasound examination and computed tomographic scanning, the frequency of the diagnosis of incidental renal cell carcinoma is increasing, which is often found either symptomless or early staged. The current treatment paradigm is the well-documented radical nephrectomy. But with the evidence accumulating, radical nephrectomy is one of the most dangerous factors leading to chronic kidney failure, which is the independent predictor of high incidence of cardiovascular event. Nephron-sparing surgery has become the alternative surgery in the treatment of small renal masses, which was mostly performed in patients diagnosed with stage cT1 renal cell carcinoma. Partial nephrectomy for cT1 a tumors had been shown to be equal to radical nephrectomy in cancer control, and demonstrated better preservation of renal function. Likewise, many clinical research have indicated that the result was found in the treatment of cT1 b RCC. However, some research implied that the possibility of malignancy, mutiple-focality and complexity of the tumors increased accompany the increasing of the tumor size. Consequently, partial nephrectomy remains underused. Objective: To compare overall survival rate, cancer specific survive rate, renal function, and complications of the two operation, we searched authority databases and performed a systematic review and meta-analysis of partial vs radical nephrectomy for cT1 b renal cell carcinoma. Material and method: Pubmed was searched with key words, such as “partial nephrectomy”, “nephron-sparing surgery”, “radical nephrectomy”, “renal cell carcinoma” and ”renal tumor”. Hazard ratio(HR), risk ratio(RR) and 95% Confidence interval were used to compare overall survival rate, cancer specific survive rate, renal function, and complications of the two operation. Accordingly, the standard mean difference and 95% Confidence interval were used to evaluate the decrease of Glomerular filtration rate treated by partial nephrectomy and radical nephrectomy. Meta-analysis was used to analyze the extracted data by Stata ®(Version12.0,Stata Corporation,College Station,Texas,USA). Result: 11 clinical researches were selected from 736 researches retrieved from Pubmed. A total of 10122 patients diagnosed with cT1 b renal cell carcinoma were included,.Among which 1125 were treated with partial nephrectomy, while 8997 patients were treated with radical nephrectomy. After Meta analysis by using Stata(Version12.0), we concluded that: the difference of cancer specific survival rate between the two surgery was not significantly(HR=1.22,95%CI(0.91~1.63),p=0.176); Overall survival rate was better in the partial nephrectomy group(HR=0.725,95%CI(0.553~0.950),p=0.019); Cancer progression rate between the two groups was comparable(RR=0.76,95%CI(0.445~1.296),p=0.313); Preservation of kidney function was better for those undergoing PN; The average decrease of GFR was higher in the RN group(SMD=-0.574,95%CI(-0.716~-0.431),p<0.001). The difference ofcomplications between the two surgery was not significantly(RR=1.337,95%CI(0.975~1.833),p=0.071). Conclusion: 1、No obvious difference was found between PN and RN group in cancer specific survival rate in the treatment of cT1 b RCC. However, PN showed an obvious advantage over RN in the overall survival rate; 2、Due to the preservation of renal units, the decrease of Glomerular filtration rate in the PN group was less than RN group, consequently, the incidence of CKD,which can lead to a higher mortality caused by cardiovascular disease, was higher in the PN group than that in the RN group; 3、Although the incidence of hematuria and urinary fistula were higher in some study, the meta-analysis showed no obvious difference between the two groups; 4、With skilled technology, PN can be an alternative way in the treatment of cT1b RCC. |
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