Woldu Solomon L, Weinberg Aaron C, Korets Ruslan, Ghandour Rashed, Danzig Matthew R, RoyChoudhury Arindam, Kalloo Sean D, Benson Mitchell C, DeCastro G Joel, McKiernan James M
Department of Urology, Columbia University Medical Center, New York, NY.
Department of Urology, Columbia University Medical Center, New York, NY.
Urology. 2014 Oct;84(4):860-7. doi: 10.1016/j.urology.2014.05.061.
To analyze the influence of preoperative renal function on postoperative renal outcomes after radical nephrectomy (RN) and nephron-sparing surgery (NSS) for malignancy in patients stratified according to preoperative chronic kidney disease (CKD) stage and surgical extent (NSS vs RN).
Retrospective review of patients undergoing renal surgery for localized renal masses stratified by surgical extent and preoperative CKD stage based on glomerular filtration rate (GFR) level: stage I (>90 mL/min/1.73 m(2)), stage II (60-89 mL/min/1.73 m(2)), and stage III (30-59 mL/min/1.73 m(2)). Survival analysis for significant renal impairment was based on freedom from the development of new-onset GFR <30 or <45 mL/min/1.73 m(2).
A total of 1306 patients were included in the analysis with preoperative CKD stage I (27.9%), II (52.1%), and III (20.1%); 41.3% and 58.7% underwent NSS and RN, respectively. NSS was associated with a lower annual rate of GFR decline in preoperative CKD stage-I (P = .028) and stage-II patients (P = .018), but not in CKD stage-III patients (P = .753). Overall, 5.0% and 15.0% developed new-onset GFR <30 mL/min/1.73 m(2) and <45 mL/min/1.73 m(2), respectively. There was no difference in the probability of developing significant renal impairment between NSS and RN in CKD stage-I or -III patients, whereas only in CKD stage-II patients was the surgical extent independently associated with development of significant renal impairment (RN: odds ratio, 9.0; P = .042 for GFR <30 mL/min/1.73 m(2) and odds ratio, 2.3; P = .003 for GFR <45 mL/min/1.73 m(2)).
Compared with RN, NSS is associated with a lower rate of GFR decline for preoperative CKD stage-I and -II patients, but only CKD stage-II patients demonstrated a decreased risk of developing significant renal impairment.
分析根据术前慢性肾脏病（CKD）分期及手术范围（保留肾单位手术[NSS]与根治性肾切除术[RN]）分层的患者，术前肾功能对恶性肿瘤行根治性肾切除术（RN）及保留肾单位手术（NSS）术后肾脏转归的影响。
回顾性分析接受肾脏手术治疗局限性肾肿块的患者，根据手术范围及基于肾小球滤过率（GFR）水平的术前CKD分期进行分层：I期（>90 mL/min/1.73 m²）、II期（60 - 89 mL/min/1.73 m²）及III期（30 - 59 mL/min/1.73 m²）。对显著肾功能损害的生存分析基于新发GFR <30或<45 mL/min/1.73 m²未发生的情况。
共有1306例患者纳入分析，术前CKD分期为I期（27.9%）、II期（52.1%）及III期（20.1%）；分别有41.3%和58.7%的患者接受了NSS和RN。NSS与术前CKD I期（P = 0.028）和II期患者（P = 0.018）较低的GFR年下降率相关，但在CKD III期患者中无相关性（P = 0.753）。总体而言，分别有5.0%和15.0%的患者出现新发GFR <30 mL/min/1.73 m²和<45 mL/min/1.73 m²。在CKD I期或III期患者中，NSS和RN发生显著肾功能损害的概率无差异，而仅在CKD II期患者中，手术范围与显著肾功能损害的发生独立相关（对于GFR <30 mL/min/1.73 m²，RN：比值比为9.0；P = 0.042；对于GFR <45 mL/min/1.73 m²，比值比为2.3；P = 0.003）。
与RN相比，NSS与术前CKD I期和II期患者较低的GFR下降率相关，但仅CKD II期患者发生显著肾功能损害的风险降低。
