Dong Wen, Zhang Zhiling, Zhao Juping, Wu Jitao, Suk-Ouichai Chalairat, Aguilar Palacios Diego, Caraballo Antonio Elvis, Babbar Sanam, Remer Erick M, Li Jianbo, Isharwal Sudhir, Zabell Joseph, Campbell Steven C
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Department of Urology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
Urology. 2017 May;103:129-135. doi: 10.1016/j.urology.2016.12.021. Epub 2016 Dec 21.
To evaluate whether excised parenchymal mass (EPM) during partial nephrectomy (PN) correlates with functional decline and can serve as a surrogate for functional outcomes.
All 215 patients managed with PN for unifocal renal mass with necessary studies to determine EPM and percent glomerular filtration rate (GFR) and parenchymal mass preserved (both global and specific to the operated kidney) were analyzed. EPM was estimated from the pathologic specimen by subtracting the tumor mass from the specimen mass, with both calculated using the elliptical formula. Vascularized parenchymal mass preserved was measured from computed tomography scans obtained <2 months prior and 3-12 months after surgery. All functional analyses were required to be within the same time frames, and patients with a contralateral kidney were also required to have nuclear renal scans.
The median tumor size was 3.5 cm and the median R.E.N.A.L. was 7. Warm and cold ischemia were utilized in 123 and 92 patients, respectively (median ischemia time = 23 minutes). The median global GFR preserved was 89%, the median total parenchymal mass preserved was 93%, and the median estimated EPM was 16 cm. Whereas percent parenchymal mass preserved correlated strongly with global and ipsilateral GFR preserved (both P < .001), EPM failed to correlate with functional outcomes on both univariable and multivariable analyses.
Our data suggest that parenchymal mass preserved with standard PN by experienced surgeons associates strongly with function preserved, whereas EPM fails to correlate with functional outcomes. Further study of the functional impact of EPM in other circumstances will be required, such as enucleation or PN performed by less-experienced surgeons.
评估部分肾切除术（PN）期间切除的实质肿块（EPM）是否与功能下降相关，并能否作为功能结局的替代指标。
分析了所有215例接受PN治疗单灶性肾肿块的患者，这些患者均进行了必要的研究以确定EPM、肾小球滤过率（GFR）百分比以及保留的实质肿块（整体和患侧肾脏特异性）。通过从病理标本质量中减去肿瘤质量来估算EPM，两者均使用椭圆公式计算。从术前<2个月和术后3 - 12个月获得的计算机断层扫描测量保留的带血管实质肿块。所有功能分析都要求在相同的时间范围内进行，对侧肾脏的患者还需要进行核肾扫描。
肿瘤大小中位数为3.5 cm，R.E.N.A.L.中位数为7。分别有123例和92例患者采用了热缺血和冷缺血（缺血时间中位数 = 23分钟）。保留的整体GFR中位数为89%，保留的总实质肿块中位数为93%，估计的EPM中位数为16 cm。虽然保留的实质肿块百分比与保留的整体和同侧GFR密切相关（均P <.001），但在单变量和多变量分析中，EPM均与功能结局无关。
我们的数据表明，经验丰富的外科医生进行标准PN时保留的实质肿块与保留的功能密切相关，而EPM与功能结局无关。需要进一步研究EPM在其他情况下的功能影响，例如由经验较少的外科医生进行的剜除术或PN。
