Klingler Michael J, Babitz Stephen K, Kutikov Alexander, Campi Riccardo, Hatzichristodoulou Georgios, Sanguedolce Francesco, Brookman-May Sabine, Akdogan Bulent, Capitanio Umberto, Roscigno Marco, Volpe Alessandro, Marszalek Martin, Uzzo Robert G, Antonelli Alessandro, Langenhuijsen Johan, Carini Marco, Minervini Andrea, Lane Brian R
Michigan State University College of Human Medicine, Grand Rapids, MI.
Spectrum Health Hospital System, Grand Rapids, MI.
Urol Oncol. 2019 Jan;37(1):33-39. doi: 10.1016/j.urolonc.2018.11.007. Epub 2018 Nov 23.
Partial nephrectomy (PN) is standard for small renal masses, improving renal function by preserving renal parenchyma compared with radical nephrectomy. Recent work demonstrated that postoperative surgeon assessment of volume preservation (SAVP) and 3D imaging measurements agree and correlate with postoperative function. We hypothesize preoperative assessment of volume preservation (PAVP) with PN based on preoperative imaging will reliably indicate postoperative renal function.
Data were collected from 336 patients undergoing PN for suspected renal cancer by 40 surgeons at 12 centers in Europe and the United States within the Surface-Intermediate-Base International Consortium. Surgeons recorded PAVP and SAVP for individual patients; pre- and postoperative glomerular filtration rate (GFR) was estimated by Chronic Kidney Disease Epidemiology Collaboration equations. Correlations between PAVP, SAVP, and postoperative GFR were assessed with linear regression models. Bland-Altman analysis was used to assess agreement between PAVP and SAVP with a significant cutoff of 5%.
Median PAVP was 90% (interquartile range [IQR] 85%-100%) and SAVP was 90% (IQR: 80%-94%). PAVP and SAVP were moderately correlated (R = 0.67, P < 0.0001) and deemed "interchangeable" by Bland-Altman analysis at a 5% acceptable rate of difference (95% CI: -5.4, -3.1). Median postoperative GFR was 77.3 (IQR: 56.2, 92.0). Both PAVP (R = 0.82, P < 0.0001) and SAVP (R = 0.83, P < 0.0001) were correlated with postoperative GFR. Multivariable models utilizing volume-adjusted GFR based on PAVP or SAVP significantly and similarly predicted postoperative GFR (R = 0.72 for each).
Renal function is closely linked to the amount of parenchymal volume preservation, whether estimated prior to surgery (PAVP) or afterward (SAVP). PAVP provides reasonably accurate information for decision-making in patients considering PN.
对于小肾肿瘤，部分肾切除术（PN）是标准术式，与根治性肾切除术相比，它通过保留肾实质来改善肾功能。最近的研究表明，术后外科医生对保留肾单位体积的评估（SAVP）与三维成像测量结果一致，且与术后肾功能相关。我们假设基于术前影像学检查对PN的保留肾单位体积进行术前评估（PAVP）将可靠地提示术后肾功能。
在欧洲和美国12个中心的40名外科医生通过表面 - 中间 - 基底国际联盟，收集了336例因疑似肾癌接受PN的患者的数据。外科医生记录了个体患者的PAVP和SAVP；术前和术后的肾小球滤过率（GFR）通过慢性肾脏病流行病学协作组方程进行估算。使用线性回归模型评估PAVP、SAVP与术后GFR之间的相关性。采用Bland - Altman分析评估PAVP和SAVP之间的一致性，显著差异界值为5%。
PAVP中位数为90%（四分位间距[IQR] 85% - 100%），SAVP中位数为90%（IQR：80% - 94%）。PAVP和SAVP中度相关（R = 0.67，P < 0.0001），通过Bland - Altman分析，在5%的可接受差异率下被认为“可互换”（95% CI： - 5.4， - 3.1）。术后GFR中位数为77.3（IQR：56.2，92.0）。PAVP（R = 0.82，P < 0.0001）和SAVP（R = 0.83，P < 0.0001）均与术后GFR相关。基于PAVP或SAVP使用体积校正GFR的多变量模型均显著且相似地预测了术后GFR（两者R均为0.72）。
肾功能与保留的实质体积量密切相关，无论是术前估计（PAVP）还是术后估计（SAVP）。PAVP为考虑接受PN的患者的决策提供了合理准确的信息。
