Mukkamala Anudeep, He Chang, Weizer Alon Z, Hafez Khaled S, Miller David C, Montgomery Jeffrey S, Bitzer Markus, Stuart Wolf J
Department of Urology, University of Michigan Hospitals and Health Centers, Ann Arbor, MI.
Division of Nephrology, University of Michigan Hospitals and Health Centers, Ann Arbor, MI.
Urol Oncol. 2014 Nov;32(8):1247-51. doi: 10.1016/j.urolonc.2014.04.012. Epub 2014 May 17.
Preservation of renal function is the major benefit of partial over radical nephrectomy. We evaluated patients undergoing minimally invasive partial nephrectomy (MIPN) to better understand factors predicting long-term renal function.
We identified 358 patients who underwent MIPN for confirmed renal cell carcinoma between 1998 and 2011 with a serum creatinine level at least 1 year postoperatively. Exposure variables included demographic, clinical, and perioperative information. The primary outcome was clinically significant progression of chronic kidney disease (CKD) class, defined as estimated glomerular filtration rate (eGFR) decreasing from >60 to<60, from 30 to 60 to <30, or from 15 to 30 to<15. Bivariate and multivariate analyses were performed.
Median follow-up was 39 months. Only 7 patients had a solitary kidney. A total of 47 patients (13%) had CKD class progression. The estimates for remaining free of CKD class progression at 5, 7, and 10 years were 86.98%, 75.45%, and 53.54%, respectively. On multivariate analysis, lower preoperative eGFR (odds ratio [OR] = 0.97, 95% CI: 0.96-0.98), larger tumor size (OR = 1.22, 95% CI: 1.01-1.48), and longer ischemia time (OR = 1.03, 95% CI: 1.01-1.05) were associated with CKD class progression.
Clinically significant progression of CKD occurs in a minority of patients 5 years after MIPN, but in almost one-half, it occurs 10 years after surgery. Lower preoperative eGFR and larger tumor size are associated with greater incidence of CKD progression. Longer ischemia time, even when most patients had 2 kidneys and when controlling for other factors, nonetheless increased the risk of CKD progression, although this may be a marker of other unmeasured variables.
保留肾功能是部分肾切除术相较于根治性肾切除术的主要优势。我们对接受微创部分肾切除术（MIPN）的患者进行评估，以更好地了解预测长期肾功能的因素。
我们确定了1998年至2011年间因确诊肾细胞癌接受MIPN且术后血清肌酐水平至少1年的358例患者。暴露变量包括人口统计学、临床和围手术期信息。主要结局是慢性肾脏病（CKD）分级的临床显著进展，定义为估计肾小球滤过率（eGFR）从>60降至<60、从30至60降至<30或从15至30降至<15。进行了双变量和多变量分析。
中位随访时间为39个月。仅7例患者为孤立肾。共有47例患者（13%）出现CKD分级进展。5年、7年和10年无CKD分级进展的估计值分别为86.98%、75.45%和53.54%。多变量分析显示，术前eGFR较低（比值比[OR]=0.97，95%可信区间：0.96-0.98）、肿瘤体积较大（OR=1.22，95%可信区间：1.01-1.48）和缺血时间较长（OR=1.03，95%可信区间：1.01-1.05）与CKD分级进展相关。
MIPN术后5年少数患者出现CKD的临床显著进展，但术后10年几乎一半患者出现该情况。术前eGFR较低和肿瘤体积较大与CKD进展发生率较高相关。缺血时间较长，即使大多数患者有两个肾脏且控制了其他因素，仍会增加CKD进展风险，尽管这可能是其他未测量变量的一个标志。
