Meta Analysis Of Clinical Efficacy Of Partial Nephrectomy And Radical Nephrectomy In The Treatment Of Stage T1b Renal Cell Carcinoma

Objective:To compare the clinical efficacy of partial nephrectomy(PN)and radical nephrectomy(RN)in the treatment of T1 b renal cell carcinoma(RCC),and to provide evidence-based medicine for the choice of clinical operation.Methods:The databases including CNKI,Wanfang,VIP,Medline,Pubmed as well as Cochrane Library were searched electronically.Search time was from created date of the database to December 1st,2016.English search terms: “partial nephrectomy” 、“nephron sparing surgery”、“radical nephrectomy”、“renal cell carcinoma”、“T1b”、“pT1b”.Chinese search terms:“partial nephrectomy ” 、 “ nephron sparing surgery ” 、 “ radical nephrectomy”、“renal cell carcinoma”、“T1b”、“pT1b”.The literatures of PN or RN in the treatment of stage T1 b RCC were collected and the clinical efficacy was compared using Meta analysis.Results:16 literatures including 34357 RCC patients were enrolled,4014 cases were in PN group and 30343 cases were in RN group,respectively.5-year overall survival rate(OS)(RR=1.05,95%CI0.98~1.12,P=0.19),10-year overall survival rate(OS)(RR=1.07,95%CI0.85~1.34,P=0.59),5-year recurrence-free survival rate(RFS)(RR=1.01,95%CI0.97~1.06,P=0.54),10-year recurrence-free survival rate(RFS)(RR=1.06,95%CI0.83~1.35,P=0.64),5-year cancer-specific survival rate(CSS)(RR=1.02,95%CI0.97~1.08,P=0.36)as well as local recurrence rate(RR=2.19,95%CI0.74~6.47,P=0.15)was not statistically different between the two groups.The rate of 10-year CSS(RR=1.04,95%CI1.03~1.05,P<0.00001)in PN group was significantly higher than that in PN group and the rate of distant metastasis(RR=0.42,95%CI0.21~0.86,P=0.02)in PN group was significantly lower than that in RN group.Conclusion:5-year and 10-year overall survival rate(OS),5-year and 10-year recurrence-free survival rate(RFS),5-year cancer-specific survival rate(CSS)as well as local recurrence rate was not statistically different between the two groups.The rate of 10-year CSS in PN group was significantly higher than that in PN group and the rate of distant metastasis in PN group was significantly lower than that in RN group.Compared with RN,treatment of PN for T1 b stage RCC could retain more nephrons to reduce the incidence of complications and enhance the life quality of patients.Thus,PN is a surgical method worthy of promotion.