Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Eur J Cancer. 2014 Jan;50(1):64-9. doi: 10.1016/j.ejca.2013.08.018. Epub 2013 Sep 20.
To investigate the impact of tumour size on postoperative glomerular filtration rate (GFR) in patients undergoing radical nephrectomy (RN) for renal cell carcinoma (RCC).
We retrospectively identified 1371 patients who underwent RN between 1995 and 2010. Serum creatinine levels were measured preoperatively, within 7days of RN, at 3months, 1 and 3years. We divided patients into three groups based on tumour size: A: ⩽4cm, B: 4-7cm, C: >7cm. The changes in GFR were compared and multivariate logistic regression was used to analyse the predictive value of tumour size for new-onset chronic kidney disease (CKD, GFR<60mL/min/1.73m(2)).
The preoperative GFR was significantly different among the three groups (A: 83.0, B: 82.0, C: 79.4ml/min/1.73m(2), P=0.040). The decrease in GFR from preoperative to within 7days was greater in group A than in groups B and C (28.2 versus 24.2 versus 18.5ml/min/1.73m(2), P<0.001). The GFR at 1year postoperative was lower in group A than in group C (58.4 versus 61.5ml/min/1.73m(2), P=0.009), in contrast to preoperative GFR. The incidence of GFR decrease >30% was higher in Group A than in Groups B and C at 1year (52.4% versus 41.5% versus 33.7%, P<0.001). On multivariate analysis Groups A and B had a 2.37-fold (95% confidence interval (CI) 1.56-3.60, P<0.001) and 2.24-fold (95% CI 1.49-3.38, P<0.001) higher risk of new-onset CKD compared with Group C.
Small tumour size is associated with CKD after RN. Partial nephrectomy should be considered in patients with tumour size 7cm or less.
研究肿瘤大小对接受根治性肾切除术（RN）治疗肾细胞癌（RCC）患者术后肾小球滤过率（GFR）的影响。
我们回顾性地确定了 1995 年至 2010 年间接受 RN 的 1371 例患者。术前、RN 后 7 天、术后 3 个月、1 年和 3 年测量血清肌酐水平。我们根据肿瘤大小将患者分为三组：A：≤4cm、B：4-7cm、C：>7cm。比较 GFR 的变化，并使用多变量逻辑回归分析肿瘤大小对新发慢性肾脏病（CKD，GFR<60mL/min/1.73m2）的预测价值。
三组间术前 GFR 有显著差异（A：83.0，B：82.0，C：79.4ml/min/1.73m2，P=0.040）。A 组从术前到术后 7 天内 GFR 下降较 B 组和 C 组更明显（28.2 比 24.2 比 18.5ml/min/1.73m2，P<0.001）。与术前 GFR 相比，A 组术后 1 年 GFR 较低（58.4 比 61.5ml/min/1.73m2，P=0.009）。1 年时，A 组 GFR 下降>30%的发生率高于 B 组和 C 组（52.4%比 41.5%比 33.7%，P<0.001）。多变量分析显示，A 组和 B 组与 C 组相比，新发 CKD 的风险分别增加 2.37 倍（95%可信区间（CI）为 1.56-3.60，P<0.001）和 2.24 倍（95%CI 为 1.49-3.38，P<0.001）。
肿瘤体积小与 RN 后 CKD 有关。对于肿瘤大小为 7cm 或更小的患者，应考虑行部分肾切除术。
