Husain Fatima Z, Rosen Daniel C, Paulucci David J, Sfakianos John P, Abaza Ronney, Badani Ketan K
1 Icahn School of Medicine at Mount Sinai , New York, New York.
2 Robotic Urologic Surgery, OhioHealth Dublin Methodist Hospital , Dublin, Ohio.
J Endourol. 2016 Oct;30(10):1099-1104. doi: 10.1089/end.2016.0337.
To assess the association between the R.E.N.A.L. Nephrometry score, the amount of non-neoplastic parenchymal volume (NNPV) removed, and the renal function decline in patients undergoing robotic partial nephrectomy (RPN).
The Multi-institutional Mount Sinai Kidney Cancer Database was used to identify 1235 patients who underwent RPN between January 2008 and February 2016, of whom 366 had complete data, including NNPV removed. Mann-Whitney U tests and univariable linear regression models were used to assess the relationships between R.E.N.A.L. Nephrometry score, warm ischemia time (WIT), and NNPV removed. Univariable and multivariable regression models were then used to assess the independent relationships of each of these variables with percent change in estimated glomerular filtration rates (eGFR) and acute kidney injury (AKI) within the first 30 postoperative days in addition to percent change in eGFR and progression to chronic kidney disease at a median follow-up of 6.9 months.
Increasing R.E.N.A.L. Nephrometry score was shown to be a predictor of WIT (β = 0.92, p < 0.001) and of NNPV removed (β = 6.21, p < 0.001) in univariable analyses. In multivariable analysis, postoperative reduction in eGFR within the first 30 days of surgery was associated with both R.E.N.A.L. Nephrometry score (β = -2.02, p < 0.001) and NNPV removed (β = -5.19, p = 0.015). R.E.N.A.L. Nephrometry score (OR = 1.21, p = 0.013) and NNPV removed (OR = 1.90, p = 0.013) were also associated with an increased likelihood of AKI within the first 30 days. No significant association in this cohort was found between R.E.N.A.L. Nephrometry score, NNPV removed, or WIT and renal function decline at 6.9 months.
The preoperative R.E.N.A.L. Nephrometry score can be used to predict postoperative pathologically determined healthy renal volume loss or NNPV removed. Removal of not just the tumor but also the healthy surrounding parenchyma is important in determining renal function decline. As our understanding of the importance of renal volume loss grows, NNPV removed gains increasing utility as an easily determinable postoperative variable.
评估接受机器人辅助部分肾切除术（RPN）的患者中，R.E.N.A.L.肾计量评分、非肿瘤性实质体积（NNPV）切除量与肾功能下降之间的关联。
利用多机构西奈山肾癌数据库，确定2008年1月至2016年2月期间接受RPN的1235例患者，其中366例有完整数据，包括切除的NNPV。采用曼-惠特尼U检验和单变量线性回归模型，评估R.E.N.A.L.肾计量评分、热缺血时间（WIT）与切除的NNPV之间的关系。然后，采用单变量和多变量回归模型，评估这些变量中的每一个与术后30天内估计肾小球滤过率（eGFR）变化百分比、急性肾损伤（AKI）以及在6.9个月的中位随访期内eGFR变化百分比和进展为慢性肾病之间的独立关系。
在单变量分析中，R.E.N.A.L.肾计量评分增加被证明是WIT（β = 0.92，p < 0.001）和切除的NNPV（β = 6.21，p < 0.001）的预测指标。在多变量分析中，术后30天内eGFR降低与R.E.N.A.L.肾计量评分（β = -2.02，p < 0.001）和切除的NNPV（β = -5.19，p = 0.015）均相关。R.E.N.A.L.肾计量评分（OR = 1.21，p = 0.013）和切除的NNPV（OR = 1.90，p = 0.013）也与术后30天内AKI可能性增加相关。在该队列中，未发现R.E.N.A.L.肾计量评分、切除的NNPV或WIT与6.9个月时的肾功能下降之间存在显著关联。
术前R.E.N.A.L.肾计量评分可用于预测术后病理确定的健康肾体积丢失或切除的NNPV。不仅切除肿瘤，而且切除周围健康实质对于确定肾功能下降很重要。随着我们对肾体积丢失重要性的认识不断增加，切除的NNPV作为一个易于确定的术后变量，其效用越来越大。
