肾肿瘤治疗方法待改变

Report Suggests Changing Kidney Tumor Treatment

报告建议改变肾肿瘤治疗方法

　　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.

　　在超过40年的时间里，美国外科医生都用同样的办法——肾切除术，即完全切除整个肾，治疗那些已经发现的小的肾肿瘤。但是新的研究强烈建议说这一方法并不能提高病患者的生存几率。

　　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.

　　患有肾部皮层肿瘤的患者在实施肾切除术后会患慢性肾病：柳叶刀肿瘤学会的群组研究回顾：完全切除整个肾脏而不是肿瘤本身和邻近的组织更可能损伤另外一个违背切除肾。

　　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.

　　研究人员报告说，在2006年超过35000人将会罹患这种叫做肾表层肿瘤的疾病。一般的肿瘤是恶性的肿瘤，超过60%的肿瘤直径小于4厘米。就是这些小肿瘤可以采用部分切除法而不是采取完全切除法。

　　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.

　　研究人员分析了超过2000个患者的资料，这些患者都是在过去十六年中因为小的肾部肿瘤而采取手术治疗，但都保持了两个功能正常的肾。研究人员并没有把那些病情发生转移的患者包含在内。

　　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.

　　经过平衡年龄、肾功能、糖尿病、高血压和其他的一些因素，他们发现，在3年存续期中采用完全切除法的患者开始患慢性肾病的比例为65%，而采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.”

　　“即便是采用了部分切除法，患者的肾功能都会持续的减弱，”论文的高级作者保罗·鲁索博士说，“但是这要比采用完全切除法的好的多。”如果肾功能恶化，就有必要对此进行分析，他说，“你会有大约50%的几率活过3年，这比癌症要情况要糟得多。”

　　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.

　　研究人员说，采用完全切除的一个原因可能是部分切除在技术上更加困难。但是，调查显示，因为手术产生的并发症两者却没有什么区别。报告刊登在柳叶刀肿瘤学9月号上。

　　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.

　　纽约纪念斯隆-凯特林癌症中心的泌尿科教授卢梭博士说医生更愿意采用传统的完全切除法的原因在于直到现在，他们还认为有两个功能正常的肾的患者即便在切除一个肾也不会影响其肾功能。但是这一观点建立在检验血清肌酸酐的水平基础上，但这一检验对于找到细微的功能障碍来讲就太草率了。

　　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，科学家们使用了一种更加精密的检测手段，即肾小球的滤过功能比率检测，这与肌氨酸酐水平以及年龄、性别和种族都有关系。他们在切除手术前后对比了这一水平，用来检验肾功能是否恶化。研究人员发现大约有1/4的患有小肿瘤的患者事先就已经患有了慢性肾病。在这种情况下，失去一个肾将可能增加患肾衰竭的危险。

　　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.

　　一个肾对于大部分肾捐献者没有影响，但是卢梭博士说，这是因为肾捐献者往往是经过精挑细选，比患肾肿瘤的患者更加年轻，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.”

　　“对于直径大于7厘米的肿瘤患者，完全切除和部分切除在生存的几率上是一样的，”卢梭博士说。“与（部分切除法）保留一个肾相比，（外全切除法使）新的肿瘤生长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.”

　　他补充说，70%的小的肿瘤是在偶然的情况下发现的。当医生在使用各种成像技术认定其他的健康问题的时候，他们发现一些可能被忽略的这些器官损害。但是他们按照传统的办法来治疗这种小的肿瘤，就是把整个肾给切除。卢梭博士认为，这是一个错误，至少现在在一些医院里，医生们在集中精力想办法如何保有原来的器官。“如果你来看看我们的中心，至少有70%的患者采用部分切除法，”他说。“但是你再看看整个国家的数据，恰恰相反，80%的2厘米肿瘤的患者的肾正被完全切除。在我们看来，这是不对的。”（外语教育网 王郅译）