Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, NY.
Department of Radiology, Icahn School of Medicine at Mount Sinai, New York City, NY.
Urol Oncol. 2020 Oct;38(10):798.e1-798.e7. doi: 10.1016/j.urolonc.2020.05.016. Epub 2020 Jul 29.
To analyze the volumetric changes of the ipsilateral and contralateral kidneys and their effect on functional outcome post partial nephrectomy using segmentation analysis.
We have analyzed the data of 119 patients from a single surgeon series of partial nephrectomy patients. Median follow-up was 11.40 months. Patients with bilateral tumors, and solitary kidney were excluded from analysis. Volumetric measurements were performed using a semiautomated tissue segmentation tool. A simple linear regression model to assess the predictors for parenchymal volume loss (PVL). A multivariable linear regression model was used to evaluate the association between PVL and warm ischemia time (WIT), controlling for other factors.
Mean WIT was 12.09 ± 4.40 minutes and the mean percentage decrease in the volume of the operated kidney was 16.99 ± 13.49%. WIT (β = 1.24, P < 0.001) and tumor complexity (simple vs. intermediate, β = 0.06, P = 0.984; simple vs. high, β = 11.62,P = 0.007) were associated with PVL. A 1 minute increase in WIT was associated with an increase in the percentage volume loss in the operated kidney by 1.38% (β = 1.20, P < 0.001). Patients with high tumor complexity (β = 11.17, P = 0.009) had a significantly higher percentage volume loss compared to patients with simple tumor complexity. Ipsilateral PVL (β = -0.35, P = 0.015) and male gender (β = -9.89, P = 0.021) were associated with change in eGFR. After adjusting for confounders, % volume loss (β = -0.32, P < 0.001) remained a significant predictor for contralateral hypertrophy.
Tumor complexity results in higher WIT and increased PVL as measured by volumetric segmentation. PVL is a key factor associated with functional outcome, and is directly linked to WIT. Increased PVL is also associated with decreased contralateral hypertrophy. Prospective studies with larger samples sizes will be required to validate our findings.
使用分割分析分析同侧和对侧肾脏的体积变化及其对部分肾切除术后功能结果的影响。
我们分析了来自一位外科医生系列部分肾切除术患者的 119 名患者的数据。中位随访时间为 11.40 个月。排除了双侧肿瘤和孤立肾的患者。使用半自动组织分割工具进行体积测量。采用简单线性回归模型评估实质体积损失（PVL）的预测因素。采用多元线性回归模型，控制其他因素，评估 PVL 与热缺血时间（WIT）之间的相关性。
平均 WIT 为 12.09 ± 4.40 分钟，手术肾脏体积平均下降 16.99 ± 13.49%。WIT（β=1.24，P<0.001）和肿瘤复杂性（简单与中间，β=0.06，P=0.984；简单与高，β=11.62，P=0.007）与 PVL 相关。WIT 增加 1 分钟与手术肾脏体积损失百分比增加 1.38%（β=1.20，P<0.001）相关。肿瘤复杂性高的患者（β=11.17，P=0.009）与肿瘤复杂性低的患者相比，体积损失百分比明显更高。同侧 PVL（β=-0.35，P=0.015）和男性（β=-9.89，P=0.021）与 eGFR 变化相关。调整混杂因素后，体积损失百分比（β=-0.32，P<0.001）仍然是对侧肥大的显著预测因子。
肿瘤复杂性导致 WIT 升高和体积分割测量的 PVL 增加。PVL 是与功能结果相关的关键因素，与 WIT 直接相关。PVL 增加也与对侧肥大减少相关。需要更大样本量的前瞻性研究来验证我们的发现。
