Report Suggests Changing Kidney Tumor Treatment
報告建議改變腎腫瘤治療方法
For more than 40 years, American surgeons have treated small localized tumors of the kidney the same way：with nephrectomy, the removal of the entire kidney. But new research strongly suggests that the procedure does not improve survival.
在超過40年的時間裡，美國外科醫生都用同樣的辦法——腎切除術，即完全切除整個腎，治療那些已經發現的小的腎腫瘤。但是新的研究強烈建議說這一方法並不能提高病患者的生存機率。
Chronic Kidney Disease After Nephrectomy in Patients With Renal Cortical Tumours：A Retrospective Cohort Study（The Lancet Oncology）Removing an entire kidney instead of just the tumor and nearby tissue is more likely to result in impaired function in the remaining kidney.
患有腎部皮層腫瘤的患者在實施腎切除術後會患慢性腎病：柳葉刀腫瘤學會的群組研究回顧：完全切除整個腎臟而不是腫瘤本身和鄰近的組織更可能損傷另外一個違背切除腎。
In 2006, the researchers report, more than 35,000 people will develop such lesions, called renal cortical tumors. About half of the tumors are malignant, and more than 60 percent are smaller than four centimeters in diameter. It is these small tumors that should probably be treated by partial nephrectomy, rather than the radical procedure.
研究人員報告說，在2006年超過35000人將會罹患這種叫做腎表層腫瘤的疾病。一般的腫瘤是惡性的腫瘤，超過60%的腫瘤直徑小於4釐米。就是這些小腫瘤可以採用部分切除法而不是採取完全切除法。
The researchers analyzed data from more than 2,000 patients with two functioning kidneys who underwent surgery for small renal tumors over a 16-year period. They excluded patients with metastatic disease.
研究人員分析了超過2000個患者的資料，這些患者都是在過去十六年中因為小的腎部腫瘤而採取手術治療，但都保持了兩個功能正常的腎。研究人員並沒有把那些病情發生轉移的患者包含在內。
After adjusting for age, kidney function, diabetes, hypertension and other factors, they found that the three-year probability of a patient suffering a new onset of chronic kidney disease was 65 percent for those undergoing the radical procedure, and 20 percent for those who had only the partial nephrectomy.
經過平衡年齡、腎功能、糖尿病、高血壓和其他的一些因素，他們發現，在3年存續期中採用完全切除法的患者開始患慢性腎病的比例為65%，而採用部分切除法的只有20%。
「Even in those having partial nephrectomies, there's a continued diminution in kidney function,」said Dr. Paul Russo, the senior author of the paper,「but much less than in those who have the radical operation.」If kidney function deteriorates so that dialysis becomes necessary, he said,「you've got about a 50 percent chance of three-year survival-much worse than with cancer.」
「即便是採用了部分切除法，患者的腎功能都會持續的減弱，」論文的高級作者保羅·魯索博士說，「但是這要比採用完全切除法的好的多。」如果腎功能惡化，就有必要對此進行分析，他說，「你會有大約50%的機率活過3年，這比癌症要情況要糟得多。」
One reason for the radical procedure, the researchers say, may be that a partial nephrectomy is a technically more difficult operation. Yet the frequency of complications in the two operations was no different in their study. The report appears in the September issue of The Lancet Oncology.
研究人員說，採用完全切除的一個原因可能是部分切除在技術上更加困難。但是，調查顯示，因為手術產生的併發症兩者卻沒有什麼區別。報告刊登在柳葉刀腫瘤學9月號上。
Dr. Russo, a professor of urology at Memorial Sloan-Kettering Cancer Center in New York, said another reason surgeons have opted for a total nephrectomy is that until now they have assumed a patient with two working kidneys would not have problems with kidney function after a radical nephrectomy. But that assumption is based on testing kidney function by measuring serum creatinine levels, a measure too crude to pick up subtle deficiencies in function.
紐約紀念斯隆-凱特林癌症中心的泌尿科教授盧梭博士說醫生更願意採用傳統的完全切除法的原因在於直到現在，他們還認為有兩個功能正常的腎的患者即便在切除一個腎也不會影響其腎功能。但是這一觀點建立在檢驗血清肌酸酐的水平基礎上，但這一檢驗對於找到細微的功能障礙來講就太草率了。
For the new study, the scientists used a more sensitive test called estimated glomerular filtration rate, which factors in creatinine level, along with age, sex and race. They looked at this rate before and after nephrectomy to see if kidney function had deteriorated. The researchers found that about a quarter of patients with the small tumors had pre-existing chronic kidney disease. Losing a kidney under such circumstances presents a significant danger of kidney failure.
在新的研究中，科學家們使用了一種更加精密的檢測手段，即腎小球的濾過功能比率檢測，這與肌氨酸酐水平以及年齡、性別和種族都有關係。他們在切除手術前後對比了這一水平，用來檢驗腎功能是否惡化。研究人員發現大約有1/4的患有小腫瘤的患者事先就已經患有了慢性腎病。在這種情況下，失去一個腎將可能增加患腎衰竭的危險。
Kidney donors generally have no problems functioning with one kidney, but, Dr. Russo said, this is because donors are a carefully selected population, younger and healthier than those with kidney tumors.
一個腎對於大部分腎捐獻者沒有影響，但是盧梭博士說，這是因為腎捐獻者往往是經過精挑細選，比患腎腫瘤的患者更加年輕，也更加健康。
「Survival is no better with radical or partial nephrectomy with tumors up to seven centimeters in diameter,」Dr. Russo said.「The risk of new tumor formation is minimal compared to the benefits of kidney preservation.」
「對於直徑大於7釐米的腫瘤患者，完全切除和部分切除在生存的機率上是一樣的，」盧梭博士說。「與（部分切除法）保留一個腎相比，（外全切除法使）新的腫瘤生長的可能性被降到了最低。」
He added that about 70 percent of the small tumors are discovered incidentally, when doctors using various imaging techniques to assess other medical problems find lesions that might otherwise go unnoticed. But they have typically continued to treat even the smallest tumors by removing the entire kidney. This, Dr. Russo believes, is a mistake, and at least some hospitals now concentrate more on organ preservation.「If you look at our center, at least 70 percent are getting partials here,」he said.「But you look at national databases, it's the exact opposite-80 percent of people with two-centimeter tumors are getting radical nephrectomies. That's not good, in our opinion.」
他補充說，70%的小的腫瘤是在偶然的情況下發現的。當醫生在使用各種成像技術認定其他的健康問題的時候，他們發現一些可能被忽略的這些器官損害。但是他們按照傳統的辦法來治療這種小的腫瘤，就是把整個腎給切除。盧梭博士認為，這是一個錯誤，至少現在在一些醫院裡，醫生們在集中精力想辦法如何保有原來的器官。「如果你來看看我們的中心，至少有70%的患者採用部分切除法，」他說。「但是你再看看整個國家的數據，恰恰相反，80%的2釐米腫瘤的患者的腎正被完全切除。在我們看來，這是不對的。」
（編輯：薛琳）