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术前估算肾小球滤过率对根治性膀胱切除术和非连续性尿流改道术患者生存结局的意义。

The significance of preoperative estimated glomerular filtration rate on survival outcomes in patients who underwent radical cystectomy and non-continent urinary diversion.

机构信息

Department of Urology, Bozyaka Training and Research Hospital, Izmir, Turkey.

出版信息

Int Braz J Urol. 2020 Jul-Aug;46(4):566-574. doi: 10.1590/S1677-5538.IBJU.2019.0205.

DOI:10.1590/S1677-5538.IBJU.2019.0205
PMID:32213208
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7239276/
Abstract

PURPOSE

To evaluate the influence of preoperative renal function on survival outcomes in patients who underwent radical cystectomy (RC) with non-continent urinary diversion (UD).

MATERIALS AND METHODS

A total of 132 patients with bladder cancer who underwent RC with non-continent UD due to urothelial carcinoma from January 2006 toMarch 2017 at our tertiary referral center were retrospectively evaluated. Patients were divided into 2 groups as those with estimated glomerular filtration rate (eGFR)<60mL/min/1.73 m2 and ≥60mL/min/1.73 m2 according to preoperative eGFR levels. Patients' characteristics, preoperative clinical data, operative data, pathologic data, oncologic data and complications were compared between the groups.

RESULTS

The mean age was 64.5±8.7 (range: 32 - 83) years and the median follow-up was 30.9±31.7 (range: 1-113) months. There were 46 patients in Group 1 and 86 patients in Group 2. There was no difference in cancer-specific mortality (45.6% for group 1 and 30.2% for group 2, p=0.078) and survival (56.8±8.3 months for group 1 and 70.5±5.9 months for group 2, p=0.087) between the groups. Overall mortality was higher (63% for group 1 and 40.7% for group 2, p=0.014) and overall survival (43.6±6.9 months for group 1 and 62.2±5.8 months for group 2, p=0.03) was lower in Group 1 compared to Group 2.

CONCLUSIONS

Overall mortality was higher and overall survival was lower in patients with preoperative eGFR<60mL/s. More patients had preoperative hydronephrosis with eGFR<60mL/s.

摘要

目的

评估行根治性膀胱切除术(RC)+非可控性尿流改道术(UD)的患者术前肾功能对生存结局的影响。

材料与方法

回顾性分析 2006 年 1 月至 2017 年 3 月期间,在我院接受 RC+非可控性 UD 的 132 例膀胱癌患者的资料,所有患者均为尿路上皮癌。根据术前估算肾小球滤过率(eGFR)水平将患者分为 eGFR<60mL/min/1.73m2 组和≥60mL/min/1.73m2 组。比较两组患者的特征、术前临床资料、手术资料、病理资料、肿瘤学资料和并发症。

结果

患者的平均年龄为 64.5±8.7(范围:32-83)岁,中位随访时间为 30.9±31.7(范围:1-113)个月。其中,1 组有 46 例,2 组有 86 例。两组间在癌症特异性死亡率(1 组为 45.6%,2 组为 30.2%,p=0.078)和生存(1 组为 56.8±8.3 个月,2 组为 70.5±5.9 个月,p=0.087)方面无差异。1 组的总死亡率(63%)高于 2 组(40.7%,p=0.014),总生存(1 组为 43.6±6.9 个月,2 组为 62.2±5.8 个月,p=0.03)低于 2 组。

结论

术前 eGFR<60mL/s 的患者总死亡率更高,总生存更差。eGFR<60mL/s 的患者术前更易发生肾积水。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b40e/7239276/52b740eae9e5/1677-6119-ibju-46-04-0566-gf01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b40e/7239276/52b740eae9e5/1677-6119-ibju-46-04-0566-gf01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b40e/7239276/52b740eae9e5/1677-6119-ibju-46-04-0566-gf01.jpg

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Gastric neobladders: surgical outcomes of 91 cases using different techniques.胃代膀胱术:91 例不同技术应用的手术效果。
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Preoperative chronic kidney disease is predictive of oncological outcome of radical cystectomy for bladder cancer.术前慢性肾脏病可预测膀胱癌根治性切除术的肿瘤学结局。
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术前慢性肾病预示着肌层浸润性膀胱癌患者行根治性膀胱切除术后肿瘤学预后较差。
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Biphasic decline in renal function after radical cystectomy with urinary diversion.根治性膀胱切除术后尿流改道术导致的肾功能双相下降。
Int J Clin Oncol. 2017 Apr;22(2):359-365. doi: 10.1007/s10147-016-1053-2. Epub 2016 Oct 17.
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Radical cystectomy with pelvic lymphadenectomy: pathologic, operative and morbidity outcomes in a Brazilian cohort.根治性膀胱切除术联合盆腔淋巴结清扫术:巴西队列中的病理、手术及发病率结果
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Chronic kidney disease as an important risk factor for tumor recurrences, progression and overall survival in primary non-muscle-invasive bladder cancer.慢性肾脏病是原发性非肌层浸润性膀胱癌肿瘤复发、进展及总生存期的重要危险因素。
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