肾输尿管切除术后肾功能下降较小预示上尿路上皮癌预后较差：一项多中心回顾性研究。
Smaller decline of renal function after nephroureterectomy predicts poorer prognosis of upper tract urothelial carcinoma: a multicentre retrospective study.
机构信息
Department of Urology, Teikyo University School of Medicine, Itabashi, Tokyo, Japan.
Department of Urology, Graduate School of Medicine, The University of Tokyo, Bunkyo, Tokyo, Japan.
出版信息
Jpn J Clin Oncol. 2021 Oct 5;51(10):1577-1586. doi: 10.1093/jjco/hyab081.
PURPOSE
Renal function is frequently impaired in the patients with upper tract urothelial carcinoma. We aimed to evaluate the impact of renal function and its change after surgery on survival rates in patients with upper tract urothelial carcinoma after nephroureterectomy.
METHODS
The study cohort comprised 755 patients with upper tract urothelial carcinoma who underwent nephroureterectomy between 1995 and 2016 at nine hospitals in Japan. Estimated glomerular filtration rate was calculated using the three-variable Japanese equation for glomerular filtration rate estimation from serum creatinine level and age. Outcomes were recurrence-free, cancer-specific and overall survivals. Univariate and multivariate Cox proportional hazards regression analyses were used.
RESULTS
Median patients' age was 72 years old. Pre- and post-surgical median estimated glomerular filtration rate were 55.5 and 42.9 ml/min/1.73 m2, respectively. Median estimated glomerular filtration rate decline after surgery, which represents function of the affected side kidney, was 13.1 ml/min/1.73 m2. The 5-year recurrence-free, cancer-specific and overall survivals were 68.3, 79.4 and 74.0%, respectively. Multivariate analysis indicated that lower preoperative estimated glomerular filtration rate and estimated glomerular filtration rate decline were associated with poorer recurrence-free, cancer-specific and overall survivals, but post-operative estimated glomerular filtration rate was not. Estimated glomerular filtration rate decline was more significant poor-prognosticator than preoperative estimated glomerular filtration rate. Proportions of the patients with estimated glomerular filtration rate <60 ml/min/1.73 m2 before surgery were 50.6 and 73.2% in organ-confined disease and locally advanced disease, respectively (P < 0.0001). After surgery, they were 91.6 and 89.8%, respectively (P = 0.3896).
CONCLUSIONS
Lower preoperative renal function, especially of the affected side kidney, was significantly associated with poor prognosis after nephroureterectomy for upper tract urothelial carcinoma. Many patients with locally advanced disease have reduced renal function at diagnosis and even more after surgery.
目的
上尿路尿路上皮癌患者常伴有肾功能损害。本研究旨在评估肾切除术后上尿路尿路上皮癌患者肾功能及其术后变化对生存率的影响。
方法
该研究纳入了 1995 年至 2016 年在日本 9 家医院接受肾输尿管切除术的 755 例上尿路尿路上皮癌患者。使用基于血清肌酐水平和年龄的三变量日本肾小球滤过率估算方程估算肾小球滤过率。结局指标为无复发生存率、癌症特异性生存率和总生存率。采用单因素和多因素 Cox 比例风险回归分析。
结果
患者中位年龄为 72 岁。术前和术后中位估算肾小球滤过率分别为 55.5 和 42.9 ml/min/1.73 m2。术后估算肾小球滤过率下降（代表受影响侧肾脏的功能）中位数为 13.1 ml/min/1.73 m2。5 年无复发生存率、癌症特异性生存率和总生存率分别为 68.3%、79.4%和 74.0%。多因素分析表明，术前估算肾小球滤过率较低和估算肾小球滤过率下降与无复发生存率、癌症特异性生存率和总生存率较差相关，但术后估算肾小球滤过率则不然。估算肾小球滤过率下降比术前估算肾小球滤过率更能预示预后不良。术前估算肾小球滤过率<60 ml/min/1.73 m2 的患者中，局限于器官的疾病和局部晚期疾病的比例分别为 50.6%和 73.2%（P<0.0001）。术后，这一比例分别为 91.6%和 89.8%（P=0.3896）。
结论
术前肾功能较低，尤其是患侧肾功能，与上尿路尿路上皮癌肾输尿管切除术后预后不良显著相关。许多局部晚期疾病患者在诊断时就已经存在肾功能下降，术后甚至更为严重。
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