Park Bong Hee, Sung Hyun Hwan, Jeong Byong Chang, Seo Seong Ii, Jeon Seong Soo, Lee Hyun Moo, Choi Han Yong, Jeon Hwang Gyun
Department of Urology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 135-710, Republic of Korea.
Int Urol Nephrol. 2016 Jun;48(6):977-83. doi: 10.1007/s11255-016-1250-y. Epub 2016 Feb 26.
To assess the association between tumor size and postoperative compensatory hypertrophy of the contralateral kidney estimated with preoperative and postoperative CT in patients with renal cell carcinoma (RCC).
We prospectively identified 728 patients who underwent radical nephrectomy for RCC between 2012 and 2014. Contrast-enhanced CT was done within 3 months preoperatively and 1 year postoperatively. A tissue segmentation tool program with CT images was used to estimate kidney volume. We divided patients into three groups according to tumor size (A: ≤4 cm, B: 4-7 cm, C: >7 cm). Preoperative and postoperative volumetric kidney parameters were compared and multivariable linear regression model was used to analyze predictors associated with postoperative compensatory hypertrophy.
The preoperative median contralateral kidney volume was significantly larger in group C than in groups A and B (A: 170.3, B: 176.9, C: 186.8 mL, p < 0.05); the median tumor-side renal parenchymal volume was smaller in group C than in the other groups (A: 168.4, B: 171.1, C: 139.0 mL, p < 0.001). However, the postoperative median contralateral kidney volume among the three groups was not significantly different; the median contralateral kidney volume change after surgery was significantly larger in groups A and B than in group C (A: 37.8, B: 37.5, C: 27.4 mL, p < 0.05). Tumor size (≤7 cm) (p = 0.001) and male gender (p < 0.001) were significantly correlated with increased contralateral kidney volume on multivariable analysis. Tumor size showed the strongest positive association with postoperative contralateral kidney volume (A vs. C, partial regression coefficient = 10.6; B vs. C, partial regression coefficient = 10.5).
Tumor size (≤4 or 4-7 cm) and male gender are significant factors associated with compensatory hypertrophy after surgery.
通过术前和术后CT评估肾细胞癌（RCC）患者肿瘤大小与对侧肾脏术后代偿性肥大之间的关联。
我们前瞻性地纳入了2012年至2014年间因RCC接受根治性肾切除术的728例患者。术前3个月内及术后1年进行了对比增强CT检查。使用带有CT图像的组织分割工具程序来估计肾脏体积。我们根据肿瘤大小将患者分为三组（A组：≤4 cm，B组：4 - 7 cm，C组：>7 cm）。比较术前和术后的肾脏体积参数，并使用多变量线性回归模型分析与术后代偿性肥大相关的预测因素。
C组术前对侧肾脏中位体积显著大于A组和B组（A组：170.3 mL，B组：176.9 mL，C组：186.8 mL，p < 0.05）；C组肿瘤侧肾实质体积中位值小于其他组（A组：168.4 mL，B组：171.1 mL，C组：139.0 mL，p < 0.001）。然而，三组术后对侧肾脏中位体积无显著差异；A组和B组术后对侧肾脏体积变化中位值显著大于C组（A组：37.8 mL，B组：37.5 mL，C组：27.4 mL，p < 0.05）。多变量分析显示，肿瘤大小（≤7 cm）（p = 0.001）和男性性别（p < 0.001）与对侧肾脏体积增加显著相关。肿瘤大小与术后对侧肾脏体积的正相关性最强（A组与C组比较，偏回归系数 = 10.6；B组与C组比较，偏回归系数 = 10.5）。
肿瘤大小（≤4 cm或4 - 7 cm）和男性性别是术后代偿性肥大的重要相关因素。
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