Falagario Ugo G, Martini Alberto, Pfail John, Treacy Patrick-Julien, Okhawere Kennedy E, Dayal Bheesham D, Sfakianos John P, Abaza Ronney, Eun Daniel D, Bhandari Akshay, Porter James R, Hemal Ashok K, Badani Ketan K
Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Department of Urology, University of Foggia, Foggia, Italy.
Transl Androl Urol. 2020 Apr;9(2):863-869. doi: 10.21037/tau.2019.09.31.
The role of race on functional outcomes after robotic partial nephrectomy (RPN) is still a matter of debate. We aimed to evaluate the clinical and pathologic characteristics of African American (AA) and Caucasian patients who underwent RPN and analyzed the association between race and functional outcomes.
Data was obtained from a multi-institutional database of patients who underwent RPN in 6 institutions in the USA. We identified 999 patients with complete clinical data. Sixty-three patients (6.3%) were AA, and each patient was matched (1:3) to Caucasian patients by age at surgery, gender, Charlson Comorbidity Index (CCI) and renal score. Bivariate and multivariate logistic regression analyses were used to evaluate predictors of acute kidney injury (AKI). Kaplan-Meier method and multivariable semiparametric Cox regression analyses were performed to assess prevalence and predictors of significant eGFR reduction during follow-up.
Overall, 252 patients were included. AA were more likely to have hypertension (58.7% 35.4%, P=0.001), even after 1:3 match. Overall 42 patients (16.7%) developed AKI after surgery and 35 patients (13.9%) developed significant eGFR reduction between 3 and 15 months after RAPN. On multivariate analysis, AA race did not emerge as a significant factor for predicting AKI (OR 1.10, P=0.8). On Cox multivariable analysis, only AKI was found to be associated with significant eGFR reduction between 3 and 15 months after RAPN (HR 2.49, P=0.019).
Although African American patients were more likely to have hypertension, renal function outcomes of robotic partial nephrectomies were not significantly different when stratified by race. However, future studies with larger cohorts are necessary to validate these findings.
种族对机器人辅助部分肾切除术（RPN）后功能结局的影响仍存在争议。我们旨在评估接受RPN的非裔美国（AA）和白人患者的临床和病理特征，并分析种族与功能结局之间的关联。
数据来自美国6家机构接受RPN患者的多机构数据库。我们确定了999例具有完整临床数据的患者。63例患者（6.3%）为非裔美国人，根据手术年龄、性别、Charlson合并症指数（CCI）和肾脏评分，将每名患者与白人患者按1:3进行匹配。采用双变量和多变量逻辑回归分析评估急性肾损伤（AKI）的预测因素。采用Kaplan-Meier法和多变量半参数Cox回归分析评估随访期间估算肾小球滤过率（eGFR）显著降低的发生率和预测因素。
总体而言，纳入了252例患者。即使在1:3匹配后，非裔美国人患高血压的可能性更高（58.7%对35.4%，P=0.001）。总体而言，42例患者（16.7%）术后发生AKI，35例患者（13.9%）在机器人辅助部分肾切除术后3至15个月出现eGFR显著降低。多变量分析显示，非裔美国人种族并未成为预测AKI的显著因素（比值比1.10，P=0.8）。在Cox多变量分析中，仅发现AKI与机器人辅助部分肾切除术后3至15个月eGFR显著降低相关（风险比2.49，P=0.019）。
尽管非裔美国患者患高血压的可能性更高，但按种族分层时，机器人辅助部分肾切除术的肾功能结局并无显著差异。然而，需要未来更大队列的研究来验证这些发现。
