Tanaka Nobumichi, Fujimoto Kiyohide, Tani Mitsuru, Yoshii Masahito, Yoshida Katsunori, Hirao Yoshihiko, Ozono Seiichiro
Department of Urology, Nara Medical University, Nara, Japan.
Urology. 2004 Nov;64(5):904-8. doi: 10.1016/j.urology.2004.07.006.
To investigate retrospectively whether postoperative renal function in patients with renal cell carcinoma can be preoperatively predicted by a combination of the preoperative serum creatinine (sCr) and the renal parenchymal volume (RPV) estimated by three-dimensional image reconstruction of the preoperative diagnostic imaging.
Of 155 patients who had undergone radical nephrectomy, 76 were eligible for inclusion in our study (group 1). Group 2 was comprised of 26 of 37 patients who had undergone partial nephrectomy. The postoperative RPV in both groups was estimated from the preoperative computed tomography scans or magnetic resonance imaging and were compared with the actual RPV estimated from the postoperative imaging using a three-dimensional image reconstruction program. The postoperative creatinine clearance (Ccr) was predicted from the preoperative Ccr calculated from the sCr level and by the ratio of the postoperative/preoperative RPV. The correlations between the predicted postoperative Ccr and the actual, measured postoperative Ccr were analyzed statistically.
In both groups, a statistically significant correlation was found between the postoperative RPV, estimated from the preoperative images and postoperative images. The predicted postoperative Ccr correlated significantly with the actual, measured postoperative Ccr in group 1 (r = 0.86, P <0.0001) and group 2 (r = 0.98, P <0.0001). The postoperatively increased sCr achieved stable levels within 2 to 4 weeks after nephrectomy and showed no statistically significant subsequent changes during 3 years of follow-up.
The present results demonstrated that prediction of the postoperative Ccr, using the preoperative sCr and the postoperative RPV estimated from the preoperative routine diagnostic imaging, is a simple and reliable method for the evaluation of early and medium-term postoperative renal function.
回顾性研究术前血清肌酐（sCr）与通过术前诊断成像的三维图像重建估计的肾实质体积（RPV）相结合，能否对肾细胞癌患者术后肾功能进行术前预测。
在155例行根治性肾切除术的患者中，76例符合纳入本研究的条件（第1组）。第2组由37例行部分肾切除术的患者中的26例组成。两组术后的RPV均根据术前计算机断层扫描或磁共振成像进行估计，并使用三维图像重建程序与术后成像估计的实际RPV进行比较。术后肌酐清除率（Ccr）根据术前由sCr水平计算出的Ccr以及术后/术前RPV的比值进行预测。对预测的术后Ccr与实际测量的术后Ccr之间的相关性进行统计学分析。
在两组中，术前图像和术后图像估计的术后RPV之间均存在统计学显著相关性。第1组（r = 0.86，P <0.0001）和第2组（r = 0.98，P <0.0001）中，预测的术后Ccr与实际测量的术后Ccr显著相关。肾切除术后sCr升高在术后2至4周内达到稳定水平，并且在3年随访期间没有显示出统计学显著的后续变化。
目前的结果表明，使用术前sCr和术前常规诊断成像估计的术后RPV来预测术后Ccr，是评估术后早期和中期肾功能的一种简单可靠的方法。
