School of Medicine, Nankai University, Tianjin, China.
Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.
Int J Hyperthermia. 2020;37(1):470-478. doi: 10.1080/02656736.2020.1752944.
To compare acute kidney injury (AKI) incidence between nephron sparing surgery (NSS) and microwave ablation (MWA) for T1a RCC patients, reveal the effect of AKI on survival prognosis, construct AKI nomogram and use Law of Total Probability for survival probability (SP) prediction. Patients were studied retrospectively after NSS ( = 1267) or MWA ( = 210) from January 1, 2011 to June 30, 2017. Using one to one Propensity Score Matching (PSM), 158 pairs of patients were identified for the cohort study. AKI incidence, risk factors and impact on survival outcomes were analyzed using Chi-square test, logistic and cox regression analysis. AKI risk and SP were predicted by nomogram and Law of Total Probability. The performance of the nomogram was assessed with respect to its discrimination, calibration, and clinical usefulness. AKI occurred more commonly in NSS (27.85%) cohort, when compared to MWA (17.72%) cohort ( = 0.032), but treatment modality was not independently predictive of AKI occurrence (odds ratio [OR]: 0.598; 95% confidence interval [CI]: 0.282-1.265; = 0.178). The 5-yr overall survival (OS) was lower in AKI patients (73.5%) compared with non-AKI patients (94.8%; < 0.001). AKI was an independent risk factor for all-cause mortality in RCC patients (hazard ratio [HR]: 2.820; 95% confidence interval [CI]: 1.110-7.165; = 0.029). Predictors for both NSS- and MWA-related AKI included tumor diameter, baseline eGFR and CCI score. RENAL score and tumor blood supply can predict AKI after NSS and MWA, respectively. The AKI normograms demonstrated good discrimination, with AUCs >0.86, excellent calibration and net benefits at the decision curve analysis with probabilities ≥5%. SP predicted by Law of Total Probability was comparable to actual OS. AKI was an early indicator for poor overall survival in RCC patients. It can be predicted by several oncological parameters. Nomogram and Law of Total Probability can accurately predict AKI risk and SP.
为了比较保肾手术（NSS）和微波消融（MWA）治疗 T1aRCC 患者的急性肾损伤（AKI）发生率，揭示 AKI 对生存预后的影响，构建 AKI 列线图并应用全概率定律预测生存概率（SP）。对 2011 年 1 月 1 日至 2017 年 6 月 30 日接受 NSS（ = 1267）或 MWA（ = 210）治疗的患者进行回顾性研究。采用 1:1 倾向评分匹配（PSM）方法，确定了 158 对患者进行队列研究。采用卡方检验、逻辑回归和 Cox 回归分析，分析 AKI 发生率、危险因素及对生存结局的影响。采用列线图和全概率定律预测 AKI 风险和 SP。通过区分度、校准度和临床实用性评估列线图的性能。与 MWA（17.72%）组相比，NSS（27.85%）组 AKI 发生率更高（ = 0.032），但治疗方式不是 AKI 发生的独立预测因素（比值比 [OR]：0.598；95%置信区间 [CI]：0.282-1.265； = 0.178）。AKI 患者的 5 年总生存率（OS）低于非 AKI 患者（73.5% vs. 94.8%； < 0.001）。AKI 是 RCC 患者全因死亡率的独立危险因素（风险比 [HR]：2.820；95%置信区间 [CI]：1.110-7.165； = 0.029）。NSS 和 MWA 相关 AKI 的预测因素包括肿瘤直径、基线 eGFR 和 CCI 评分。RENAL 评分和肿瘤血供分别可以预测 NSS 和 MWA 后 AKI 的发生。AKI 列线图具有良好的区分度，AUC>0.86，校准度好，决策曲线分析中概率≥5%时净效益高。全概率定律预测的 SP 与实际 OS 相当。AKI 是 RCC 患者总体生存不良的早期指标。它可以通过多种肿瘤学参数预测。列线图和全概率定律可以准确预测 AKI 风险和 SP。
