Kim Hwanik, Kim Jung Kwon, Kim Jin Hyuck, Choi Joon Hyeok, Hong Sung Kyu, Lee Sangchul, Lee Hakmin, Byun Seok-Soo
Department of Urology, Seoul National University Bundang Hospital, Seongnam, South Korea.
Department of Chemistry, School of Arts and Science, Boston College, Chestnut Hill, MA, USA.
Ann Surg Oncol. 2022 Feb;29(2):1476-1485. doi: 10.1245/s10434-021-10718-3. Epub 2021 Oct 11.
The aim of this study was to compare functional outcomes after partial nephrectomy (PN) between moderate and high complex renal tumors evaluated with a diethylenetriamine pentaacetic acid (DTPA) scan [moderate vs. high: RENAL nephrometry score (RNS) 7-9 vs. 10-12].
From January 2004 to December 2019, 471 patients with an RNS of 7-9 (moderate) and 164 patients with an RNS of 10-12 (high) who underwent PN were analyzed for renal function outcomes. The glomerular filtration rate (GFR) was measured using a DTPA scan and calculated the GFR using the Modification of Diet in Renal Disease (MDRD) formula, respectively. Trifecta/pentafecta outcome, recurrence-free survival, and overall survival were compared after propensity score matched analysis (PSMA).
After PSMA, 156 cases in each group were matched without significant difference in the preoperative factor. At the postoperative first year, there was no significant difference in the trifecta (p = 0.320), MDRD-based (p = 0.729), or DTPA-based pentafecta achievement rate (p = 0.964) between groups. At postoperative 5 years, DTPA-based total GFR (93.6% vs. 93.8%) and the operated kidney GFR preservation rate (89.9% vs. 81.7%) did not differ significantly (p > 0.05). Kaplan-Meier survival analysis showed no significant differences in survival outcomes (p > 0.05). Significant predictors of de novo chronic kidney disease (CKD) stage 3 or higher at the postoperative first year were age [hazard ratio (HR) 1.10, 95% confidence interval (CI) 1.03-1.17, p = 0.005] and preoperative DTPA-based total GFR (HR 0.94, 95% CI 0.91-0.98, p = 0.001).
High complex tumors can be treated with PN without significant deterioration in renal function. The postoperative function of the operated kidney was preserved by up to 80% in the long term compared with the preoperative period. However, PN should be selectively performed with caution to avoid the occurrence of postoperative CKD.
本研究旨在比较经二乙三胺五乙酸（DTPA）扫描评估的中度和高度复杂肾肿瘤患者行部分肾切除术（PN）后的功能结局[中度 vs. 高度：肾计量评分（RNS）7 - 9分 vs. 10 - 12分]。
对2004年1月至2019年12月期间接受PN的471例RNS为7 - 9分（中度）和164例RNS为10 - 12分（高度）的患者进行肾功能结局分析。分别使用DTPA扫描测量肾小球滤过率（GFR），并使用肾脏病饮食改良（MDRD）公式计算GFR。在倾向评分匹配分析（PSMA）后比较三连胜/五连胜结局、无复发生存率和总生存率。
PSMA后，每组156例匹配，术前因素无显著差异。术后第一年，两组间三连胜（p = 0.320）、基于MDRD的（p = 0.729）或基于DTPA的五连胜达成率（p = 0.964）无显著差异。术后5年，基于DTPA的总GFR（93.6% vs. 93.8%）和患肾GFR保留率（89.9% vs. 81.7%）无显著差异（p > 0.05）。Kaplan - Meier生存分析显示生存结局无显著差异（p > 0.05）。术后第一年新发慢性肾脏病（CKD）3期或更高分期的显著预测因素为年龄[风险比（HR）1.10，95%置信区间（CI）1.03 - 1.17，p = 0.005]和术前基于DTPA的总GFR（HR 0.94，95% CI 0.91 - 0.98，p = 0.001）。
高度复杂肿瘤可行PN治疗，且肾功能无显著恶化。与术前相比，患肾术后长期功能保留率高达80%。然而，应谨慎选择性地进行PN以避免术后CKD的发生。
