Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
J Endourol. 2021 Sep;35(9):1365-1371. doi: 10.1089/end.2020.0655. Epub 2021 Apr 28.
African American (AA) race has been identified to have a higher incidence of chronic kidney disease (CKD) and worse renal cancer survival compared with Caucasian Americans (CA), irrespective of tumor size, pathologic type, and surgical procedure. We aimed to compare the outcomes between CA and AA patients undergoing minimally invasive partial nephrectomy (PN) at our high-volume center. We queried our PN data repository from 2007 to 2017. We identified 981 cases of PN (robotic = 943 and laparoscopic = 38), of which there were 852 CA and 129 AA patients. We compared age, sex, body mass index (BMI), operative time, estimated blood loss (EBL), nephrometry score, tumor size, pre- and postoperative estimated glomerular filtration rate (eGFR), length of stay, Charlson Comorbidity Index (CCI), tumor characteristics, and 30-day complication rate. We then estimated the overall survival and disease-specific survival. Age, BMI, operative time, EBL, nephrometry score, tumor size, CCI, length of stay, and sex were not statistically different. The mean preoperative eGFR was higher in the AA cohort (91.4 mL/min/1.73 m 86.1 mL/min/1.73 m, = 0.007); however, at 1 year, there was no mean difference (76.8 mL/min/1.73 m 74.5 mL/min/1.73 m, = 0.428). There was a higher percentage of Fuhrman Grade 3/4 in the AA cohort (33.3% 22.5%, = 0.044). The AA cohort had a 2.66 × higher incidence of papillary renal cell carcinoma (RCC) (34.9% 13.1%, < 0.001) and unclassified RCC (3.9% 0.4%, = 0.001). There was no difference in tumor stage ( = 0.260) or incidence of benign histology (15.3% 11.6%, = 0.278). There were no differences in 30-day complications ( = 0.330). The median follow-up was 43.2 months. By using Kaplan-Meier curves, there was no observed difference in overall survival ( = 0.752) or disease-free survival ( = 0.403). Our cohort of AA and CA patients with intermediate follow-up showed no worse outcomes for CKD or survival when undergoing laparoscopic or robotic PN. For low-stage renal cancer, there was no difference in overall survival and disease-free survival at a median follow-up of 43.2 months among AA patients, despite having higher grade tumors and a higher percentage of unclassified RCC. Our cohort of AA patients did have a higher incidence of papillary RCC. The equivalent overall survival and disease-free survival could be due to the earlier discovery of lower stage renal masses incidentally identified on imaging studies performed equally for other reasons in both AA and CA patients.
非裔美国人（AA）种族的慢性肾脏病（CKD）发病率和肾癌生存预后均较白种人（CA）差，与肿瘤大小、病理类型和手术方式无关。我们旨在比较我们高容量中心接受微创部分肾切除术（PN）的 CA 和 AA 患者的结果。我们从 2007 年到 2017 年查询了我们的 PN 数据存储库。我们确定了 981 例 PN（机器人手术=943 例，腹腔镜手术=38 例），其中有 852 例 CA 和 129 例 AA 患者。我们比较了年龄、性别、体重指数（BMI）、手术时间、估计失血量（EBL）、肾肿瘤评分、肿瘤大小、术前和术后估计肾小球滤过率（eGFR）、住院时间、Charlson 合并症指数（CCI）、肿瘤特征和 30 天并发症发生率。然后，我们估计了总体生存率和疾病特异性生存率。年龄、BMI、手术时间、EBL、肾肿瘤评分、肿瘤大小、CCI、住院时间和性别无统计学差异。AA 组的平均术前 eGFR 较高（91.4ml/min/1.73m 86.1ml/min/1.73m， = 0.007）；然而，在 1 年时，平均差异无统计学意义（76.8ml/min/1.73m 74.5ml/min/1.73m， = 0.428）。AA 组的 Fuhrman 分级 3/4 比例较高（33.3% 22.5%， = 0.044）。AA 组的肾细胞癌（RCC）乳头状癌发生率高 2.66 倍（34.9% 13.1%， < 0.001）和未分类 RCC 发生率高 3.9 倍（3.9% 0.4%， = 0.001）。肿瘤分期无差异（ = 0.260）或良性组织学发生率无差异（15.3% 11.6%， = 0.278）。30 天并发症无差异（ = 0.330）。中位随访时间为 43.2 个月。通过 Kaplan-Meier 曲线，总体生存率（ = 0.752）或无病生存率（ = 0.403）无观察到差异。在中等随访期间，我们的 AA 和 CA 患者队列未显示出接受腹腔镜或机器人 PN 治疗时 CKD 或生存预后恶化。对于低分期肾癌，在中位随访 43.2 个月时，AA 患者的总体生存率和无病生存率无差异，尽管他们的肿瘤分级较高，未分类 RCC 的比例较高。我们的 AA 患者队列确实有较高的乳头状 RCC 发生率。总体生存率和无病生存率相当可能是由于 AA 和 CA 患者在进行其他原因的影像学检查时，偶然发现了较低分期的肾脏肿块，因此较早发现。
