Department of Urology, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
BJU Int. 2012 May;109(10):1468-73. doi: 10.1111/j.1464-410X.2011.10531.x. Epub 2011 Aug 25.
Study Type - Prognosis (case series) Level of Evidence 4 What's known on the subject? and What does the study add? At present, many studies have been executed to identify predictors for chronic kidney disease or renal insufficiency after radical nephrectomy or partial nephrectomy. We examined whether preoperative kidney volume is a predictor for renal function after radical or partial nephrectomies in RCC patients. To our knowledge, this is the first study to report on the relationship between preoperative kidney volume and changes in renal function in RCC patients who underwent radical nephrectomy or partial nephrectomy performed by one surgeon.
To investigate whether preoperative kidney volume is a prognostic factor for predicting the postoperative glomerular filtration rate (GFR) in renal cell carcinoma (RCC) patients.
We included 133 patients who underwent radical (n= 83) or partial (n= 50) nephrectomy for RCC. Kidney parenchymal volume was measured using personal computer-based software and GFR was estimated before and after surgery at 6 and 12 months. We evaluated the change in kidney volume after radical and partial nephrectomy and used regression analysis to identify predictors of lower post-surgical GFR at 12 months.
The mean volume of the normal side kidney for the radical nephrectomy group increased from 142.4 mL to 166.0 mL (17.2%) and 171.5 mL (21.2%) after surgery at 6 and 12 months, respectively. In the partial nephrectomy group, the volume of the normal side kidney increased from 127.2 mL to 138.8 mL (9.1%) and 140.6 mL (10.9%) after surgery at 6 and 12 months, respectively. The volume of the operated side kidney decreased from 128.5 mL to 102.3 mL (20.1%) and 101.8 (20.6%) after surgery at 6 and 12 months, respectively. In the radical nephrectomy group, older age (P < 0.001), preoperative volume of the normal kidney (P= 0.022) and preoperative GFR for the normal side kidney (P= 0.045) were significant predictors of lower post-surgical GFR at 12 months. In the partial nephrectomy group, older age (P= 0.001) and preoperative volume for both kidneys (P= 0.037) were significant predictors of lower post-surgical GFR at 12 months.
Preoperative kidney volume is an independent predictor of GFR in RCC patients who underwent radical or partial nephrectomy.
探讨术前肾脏体积是否为预测肾细胞癌（RCC）患者根治性肾切除或部分肾切除术后肾小球滤过率（GFR）的预后因素。
我们纳入了 133 例因 RCC 接受根治性（n=83）或部分（n=50）肾切除术的患者。使用基于个人计算机的软件测量肾实质体积，并在术前和术后 6 个月及 12 个月分别估算 GFR。我们评估了根治性和部分肾切除术后肾脏体积的变化，并使用回归分析确定 12 个月时术后 GFR 较低的预测因素。
根治性肾切除组的健侧肾脏平均体积从术前的 142.4ml 增加到术后 6 个月的 166.0ml（增加 17.2%）和 12 个月时的 171.5ml（增加 21.2%）。部分肾切除组的健侧肾脏体积从术前的 127.2ml 增加到术后 6 个月的 138.8ml（增加 9.1%）和 12 个月时的 140.6ml（增加 10.9%）。手术侧肾脏体积从术前的 128.5ml 减少到术后 6 个月的 102.3ml（减少 20.1%）和 12 个月时的 101.8ml（减少 20.6%）。在根治性肾切除组中，年龄较大（P<0.001）、术前健侧肾脏体积（P=0.022）和术前健侧 GFR（P=0.045）是术后 12 个月时 GFR 较低的显著预测因素。在部分肾切除组中，年龄较大（P=0.001）和术前双肾体积（P=0.037）是术后 12 个月时 GFR 较低的显著预测因素。
术前肾脏体积是接受根治性或部分肾切除术的 RCC 患者 GFR 的独立预测因素。
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