在上尿路尿路上皮癌合并原有肾功能损害的患者中，普遍存在的全球性肾小球硬化是肾功能不良结局的预测因素。

Predominant global glomerulosclerosis in patients of upper urinary tract urothelial carcinoma with pre-existing renal function impairment is a predictor of poor renal outcomes.

机构信息

Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Road, Kaohsiung, 80708, Taiwan.

Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, 80708, Kaohsiung, Taiwan.

出版信息

BMC Cancer. 2019 Apr 8;19(1):337. doi: 10.1186/s12885-019-5414-x.

DOI:10.1186/s12885-019-5414-x

PMID:30961555

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6454684/

Abstract

BACKGROUND

Incidence of renal dysfunction and risks of progression to end-stage renal disease (ESRD) were reported higher in upper urinary tract urothelial carcinoma (UTUC) than in renal cell carcinoma (RCC) patients after unilateral nephrectomy.

METHODS

Totally 193 renal cancer patients, including 132 UTUC and 61 RCC, were studied to clarify whether the pathological changes of the kidney remnant removed from nephrectomy and the clinical factors might predict the risk of ESRD. Renal tubulointerstitial (TI) score and global glomerulosclerosis (GGS) rate were examined by one pathologist and two nephrologists independently under same histopathological criteria.

RESULTS

The glomerular filtration rates at the time of surgery were lower in UTUC than RCC groups (p < 0.001). Average GGS score and average TI rate were higher in UTUC than in RCC groups (p < 0.001; p < 0.001). Competitive risk factor analysis revealed that abnormal GGS rate not related to age, predominant in UTUC with pre-existing renal function impairment, was a histopathological predictor of poor renal outcomes (creatinine doubling or ESRD) within 5 years in UTUC patients.

CONCLUSION

Pre-existing renal function and pathological change of kidney remnant in both UTUC and RCC have the value for prediction of renal outcomes.

摘要

背景

与肾细胞癌（RCC）患者相比，单侧肾切除术后上尿路上皮癌（UTUC）患者肾功能障碍的发生率和进展为终末期肾病（ESRD）的风险更高。

方法

共纳入 193 例肾肿瘤患者，包括 132 例 UTUC 和 61 例 RCC，旨在明确肾切除术后肾残部的病理变化和临床因素是否可以预测 ESRD 风险。由一名病理学家和两名肾病学家独立按照相同的组织病理学标准检查肾小管间质（TI）评分和全球肾小球硬化（GGS）率。

结果

UTUC 组手术时肾小球滤过率低于 RCC 组（p<0.001）。UTUC 组的平均 GGS 评分和平均 TI 率均高于 RCC 组（p<0.001；p<0.001）。竞争风险因素分析显示，与年龄无关的异常 GGS 率主要见于伴有术前肾功能损害的 UTUC，是预测 5 年内 UTUC 患者肾功能不良结局（肌酐倍增或 ESRD）的组织病理学预测因子。