Division of Urology, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy.
Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy.
Int Braz J Urol. 2018 Jul-Aug;44(4):740-749. doi: 10.1590/S1677-5538.IBJU.2017.0636.
eGFR-categories are used to predict functional outcome after partial nephrectomy (PN); no study categorized patients according to preoperative renal scan (RS) data. Aim of the study was to evaluate if stratification of patients according to RS is a reliable method to predict minor/major loss of renal function after PN.
We considered patients who underwent PN and RS pre-/post-PN for T1 tumor in our Institution (2007-2017). Demographics, perioperative and specifically functional data were analysed. On the basis of the baseline Split Renal Function (SRF), patients were stratified into risk-categories: 1) baseline operated-kidney SRF range 45-55%; 2) baseline operated-kidney SRF < 45%. Risk categories were analysed with postoperative functional outcome: postoperative operated-kidney SRF decrease below 90% of baseline was considered significant loss of function. Contingency tables and univariate/multivariate regression were analysed looking for independent factors of postoperative functional impairment.
224 patients were analysed, 125 (55.8%) maintained >90% of their baseline function. Worse probability of maintaining ≥90 baseline renal function was found in patients with Charlson's Comorbidity Index (CCI≥3) (p=0.004) and patients with PADUA score ≥8 (p=0.023). After stratification by baseline renal function, ischemia was the only independent factor: no effect on patients with poorer baseline renal function. Patients with baseline SRF 45-55% who did not experience ischemia had the highest probability to maintain ≥90% baseline SRF (p=0.028). Ischemia >25 minutes was detrimental (p=0.017).
Stratification of patients by SRF before PN is not a reliable predictor of renal functional outcome. Ischemia seems to scarcely influence patients with poorer renal function.
eGFR 类别用于预测部分肾切除术 (PN) 后的功能结果；尚无研究根据术前肾脏扫描 (RS) 数据对患者进行分类。本研究旨在评估根据 RS 对患者进行分层是否是预测 PN 后肾功能轻微/严重损失的可靠方法。
我们考虑了在我院接受 PN 和 RS 检查的 T1 期肿瘤患者（2007-2017 年）。分析了人口统计学、围手术期以及特定的功能数据。根据基线分割肾功能 (SRF)，将患者分为风险类别：1）基线手术肾脏 SRF 范围 45-55%；2）基线手术肾脏 SRF <45%。分析风险类别与术后功能结果：术后手术肾脏 SRF 下降至低于基线的 90%被认为是功能显著丧失。使用列联表和单变量/多变量回归分析寻找术后功能障碍的独立因素。
分析了 224 例患者，125 例（55.8%）保持了基线功能的>90%。发现Charlson 合并症指数（CCI≥3）（p=0.004）和 PADUA 评分≥8 的患者（p=0.023）保持基线肾功能≥90%的可能性更低。根据基线肾功能分层后，缺血是唯一的独立因素：对基线肾功能较差的患者没有影响。基线 SRF 为 45-55%且未发生缺血的患者保持≥90%基线 SRF 的概率最高（p=0.028）。缺血>25 分钟是有害的（p=0.017）。
PN 前根据 SRF 对患者进行分层不是肾功能结果的可靠预测指标。缺血似乎对肾功能较差的患者影响不大。
