Wang Julie C, Lai Weil R, Traore Elizabeth J, Liu James, Sholl Andrew B, Mandava Sree Harsha, Maddox Michael M, Mitchell Gregory C, Viriyasiripong Sarayuth, Silberstein Jonathan L, Kittles Rick, Lee Benjamin R
Department of Urology, Tulane University School of Medicine, New Orleans, LA.
Department of Pathology, Tulane University School of Medicine, New Orleans, LA.
Clin Genitourin Cancer. 2017 Apr;15(2):203-206. doi: 10.1016/j.clgc.2016.07.013. Epub 2016 Jul 22.
To identify variations in renal function and histology between Caucasian Americans (CA) and African Americans (AA) undergoing robotic nephron-sparing surgery (NSS).
A retrospective chart review was performed on patients who underwent NSS. Multivariate analysis identified factors affecting postoperative estimated glomerular filtration rate (eGFR). Histology was re-reviewed by pathology to confirm papillary type.
A total of 331 patients underwent NSS: CA (n = 212), AA (n = 105), Hispanic (n = 10), and other (n = 4). AA average age (60.1 years) was lower than CA (62.3 years) (P < .001), with a higher proportion of AA women (46%) than CA (37%) (P = .021). AA had a higher incidence of diabetes (58.2%) and hypertension (93.9%). Preoperative average eGFR was similar: 70.35 mL/min for AA versus 69.06 mL/min for CA. Average postoperative eGFR was 50.59 mL/min for AA and 57.85 mL/min for CA. Postoperative creatinine increased more in AA (0.44 mg/dL) versus CA (0.33 mg/dL) (P < .001) even when stratified by pathological stage. Clear cell renal cell carcinoma (RCC) was the most common histology with AA (45%) and CA (60%). A greater than 2-fold higher incidence of papillary RCC was observed in AA (31%) versus CA (13%). AA exhibited a greater proportion of high-grade or type 2 papillary RCC (40% and 30%) versus CA (25% and 13%).
AA patients were treated at a younger age, with a larger proportion of women. Postoperatively, AA experienced a greater increase in serum creatinine. Final histology demonstrated greater papillary RCC incidence in AA and increased likelihood for type 2 papillary RCC, a more aggressive histology.
确定接受机器人保留肾单位手术（NSS）的美国白种人（CA）和非裔美国人（AA）之间肾功能和组织学的差异。
对接受NSS的患者进行回顾性病历审查。多变量分析确定影响术后估计肾小球滤过率（eGFR）的因素。病理科对组织学进行重新审查以确认乳头类型。
共有331例患者接受了NSS：CA（n = 212）、AA（n = 105）、西班牙裔（n = 10）和其他（n = 4）。AA的平均年龄（60.1岁）低于CA（62.3岁）（P <.001），AA女性的比例（46%）高于CA（37%）（P =.021）。AA的糖尿病（58.2%）和高血压（93.9%）发病率更高。术前平均eGFR相似：AA为70.35 mL/分钟，CA为69.06 mL/分钟。术后平均eGFR，AA为50.59 mL/分钟，CA为57.85 mL/分钟。即使按病理分期分层，AA术后肌酐升高幅度（0.44 mg/dL）也大于CA（0.33 mg/dL）（P <.001）。透明细胞肾细胞癌（RCC）是AA（45%）和CA（60%）中最常见的组织学类型。与CA（13%）相比，AA中乳头状RCC的发病率高出2倍以上（31%）。与CA（25%和13%）相比，AA中高级别或2型乳头状RCC的比例更高（40%和30%）。
AA患者接受治疗的年龄较轻，女性比例较大。术后，AA的血清肌酐升高幅度更大。最终组织学显示，AA中乳头状RCC的发病率更高，且2型乳头状RCC的可能性增加，2型乳头状RCC是一种侵袭性更强的组织学类型。
