Department of Urology and Urological Surgery, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Department of Medicine II, University Medical Centre Mannheim, Theodor‑Kutzer‑Ufer 1-3, 68167, Mannheim, Germany.
World J Urol. 2021 Aug;39(8):2843-2851. doi: 10.1007/s00345-020-03556-7. Epub 2021 Jan 30.
To examine frailty and comorbidity as predictors of outcome of nephron sparing surgery (NSS) and as decision tools for identifying candidates for active surveillance (AS) or tumor ablation (TA).
Frailty and comorbidity were assessed using the modified frailty index of the Canadian Study of Health and Aging (11-CSHA) and the age-adjusted Charlson-Comorbidity Index (aaCCI) as well as albumin and the radiological skeletal-muscle-index (SMI) in a cohort of n = 447 patients with localized renal masses. Renal tumor anatomy was classified according to the RENAL nephrometry system. Regression analyses were performed to assess predictors of surgical outcome of patients undergoing NSS as well as to identify possible influencing factors of patients undergoing alternative therapies (AS/TA).
Overall 409 patient underwent NSS while 38 received AS or TA. Patients undergoing TA/AS were more likely to be frail or comorbid compared to patients undergoing NSS (aaCCI: p < 0.001, 11-CSHA: p < 0.001). Gender and tumor complexity did not vary between patients of different treatment approach. 11-CSHA and aaCCI were identified as independent predictors of major postoperative complications (11-CSHA ≥ 0.27: OR = 3.6, p = 0.001) and hospital re-admission (aaCCI ≥ 6: OR = 4.93, p = 0.003) in the NSS cohort. No impact was found for albumin levels and SMI. An aaCCI > 6 and/or 11-CSHA ≥ 0.27 (OR = 9.19, p < 0.001), a solitary kidney (OR = 5.43, p = 0.005) and hypoalbuminemia (OR = 4.6, p = 0.009), but not tumor complexity, were decisive factors to undergo AS or TA rather than NSS.
In patients with localized renal masses, frailty and comorbidity indices can be useful to predict surgical outcome and support decision-making towards AS or TA.
探讨衰弱和合并症作为保肾手术（NSS）结果的预测因素，以及作为识别主动监测（AS）或肿瘤消融（TA）候选者的决策工具。
使用加拿大健康老龄化研究的改良衰弱指数（11-CSHA）和年龄调整Charlson 合并症指数（aaCCI）以及白蛋白和放射学骨骼肌指数（SMI），评估 447 名局限性肾肿块患者的衰弱和合并症情况。根据 RENAL 肾分系统对肾肿瘤解剖进行分类。进行回归分析以评估接受 NSS 手术的患者手术结果的预测因素，并确定接受替代治疗（AS/TA）的患者的可能影响因素。
共有 409 名患者接受了 NSS，38 名患者接受了 AS 或 TA。与接受 NSS 的患者相比，接受 TA/AS 的患者更有可能衰弱或合并症（aaCCI：p<0.001，11-CSHA：p<0.001）。性别和肿瘤复杂性在不同治疗方法的患者之间没有差异。11-CSHA 和 aaCCI 被确定为 NSS 队列中主要术后并发症（11-CSHA≥0.27：OR=3.6，p=0.001）和住院再入院（aaCCI≥6：OR=4.93，p=0.003）的独立预测因素。白蛋白水平和 SMI 没有影响。aaCCI>6 和/或 11-CSHA≥0.27（OR=9.19，p<0.001）、孤立肾（OR=5.43，p=0.005）和低白蛋白血症（OR=4.6，p=0.009），而不是肿瘤复杂性，是接受 AS 或 TA 而不是 NSS 的决定因素。
在局限性肾肿块患者中，衰弱和合并症指数可用于预测手术结果，并支持向 AS 或 TA 决策。
