Larcher Alessandro, Meskawi Malek, Valdivieso Roger, Boehm Katharina, Trudeau Vincent, Tian Zhe, Fossati Nicola, Dell'Oglio Paolo, Lughezzani Giovanni, Buffi Nicolò, Sun Maxine, Karakiewicz Pierre
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, 264 Blvd. Rene-Levesque E. Room 228, Montreal, QC, H2X 1P1, Canada.
Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
World J Urol. 2016 Mar;34(3):383-9. doi: 10.1007/s00345-015-1606-4. Epub 2015 Jun 6.
Local tumor ablation (LTA) and partial nephrectomy (PN) represent treatment alternatives for patients diagnosed with small renal mass and both may result in renal function detriments. The aim of the study was to compare renal function detriments after LTA or PN.
A Surveillance epidemiology and End Results-Medicare-linked retrospective cohort of 2850 T1 kidney cancer patients who underwent LTA or PN was abstracted. Short-term outcomes consisted of 30-day acute kidney injury (AKI) and 30-day dialysis rates. Long-term outcomes consisted of episodes of AKI, mild and moderate-severe chronic kidney disease (CKD), end-stage renal disease, hemodialysis and anemia in CKD. Analyses consisted of propensity score matching, logistic and Cox regression.
After propensity score matching, 1122 patients remained. The 30-day incidence of AKI was 4.6 % after LTA and 9.4 % after PN. In multivariable analyses (MVAs), LTA was associated with a lower AKI rate (OR 0.42; p = 0.001). The 30-day incidence of any dialysis was <2 % after either LTA or PN. In MVA, LTA was not associated with a lower rate of any dialysis (OR 0.43; p = 0.2). At long-term assessment, both the unadjusted and adjusted rates of all six examined end points were not different between LTA and PN (all p > 0.5).
LTA offers short-term protective effect from AKI. The short-term rates of any dialysis treatment are similar after either LTA or PN. At long-term assessment, LTA and PN renal function detriment rates are not different. Concern for long-term functional outcomes should not be a barrier for PN.
局部肿瘤消融术（LTA）和部分肾切除术（PN）是诊断为小肾肿块患者的治疗选择，两者都可能导致肾功能损害。本研究的目的是比较LTA或PN术后的肾功能损害情况。
提取了2850例接受LTA或PN的T1期肾癌患者的监测、流行病学和最终结果 - 医疗保险关联回顾性队列。短期结局包括30天急性肾损伤（AKI）和30天透析率。长期结局包括AKI发作、轻度和中重度慢性肾脏病（CKD）、终末期肾病、血液透析以及CKD中的贫血。分析包括倾向评分匹配、逻辑回归和Cox回归。
倾向评分匹配后，剩余1122例患者。LTA术后30天AKI发生率为4.6%，PN术后为9.4%。在多变量分析（MVA）中，LTA与较低的AKI发生率相关（OR 0.42；p = 0.001）。LTA或PN术后30天任何透析的发生率均<2%。在MVA中，LTA与较低的任何透析发生率无关（OR 0.43；p = 0.2）。在长期评估中，LTA和PN之间所有六个检查终点的未调整和调整率均无差异（所有p > 0.5）。
LTA对AKI有短期保护作用。LTA或PN术后任何透析治疗的短期发生率相似。在长期评估中，LTA和PN的肾功能损害率无差异。对长期功能结局的担忧不应成为PN的障碍。
