帕拉西奥斯方程的外部验证：一种用于估计肾癌手术后新基线肾功能的简单且准确的工具。
External validation of the Palacios' equation: a simple and accurate tool to estimate the new baseline renal function after renal cancer surgery.
作者信息
Tafuri Alessandro, Sandri Marco, Martini Alberto, Capitanio Umberto, Mantica Guglielmo, Terrone Carlo, Furlan Maria, Simeone Claudio, Amparore Daniele, Porpiglia Francesco, Minervini Andrea, Mari Andrea, Cerruto Maria Angela, Antonelli Alessandro
机构信息
Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Piazzale Aristide Stefani 1, 37126, Verona, Italy.
Department of Urology, "Vito Fazzi" Hospital, Lecce, Italy.
出版信息
World J Urol. 2022 Feb;40(2):467-473. doi: 10.1007/s00345-021-03887-z. Epub 2021 Nov 26.
PURPOSE
To externally validate the Palacios' equation estimating the new baseline glomerular filtration rate (NB-GFR) after partial or radical-nephrectomy (PN, RN) for Renal cancer carcinoma (RCC).
MATERIALS AND METHODS
Our research group recently published two studies that investigated the association between renal function and cancer-specific survival in RCC. The first one included 3457 patients undergone RN or PN for a cT1-2 RCC coming from five high-volume centers; the second one considered 1767 patients undergone RN or PN for a cT1-4 RCC in a single high-volume center. From such datasets, available complete patients' data were used to calculate the predicted NB-GFR through the Palacios' equation: predicted NB-GFR = 35.03 + 0.65 ∙ preoperative GFR - 18.19 ∙ (if radical nephrectomy) - 0.25 ∙ age + 2.83 ∙ (if tumor size > 7 cm) - 2.09 ∙ (if diabetes). The observed NB-GFR was calculated by the CKD-EPI equation on serum creatinine at 3-12 months after surgery. Concordance between observed and predicted NB-GFR was evaluated by Lin's concordance correlation coefficient and Bland-Altman analysis.
RESULTS
2419 patients were included (1210, cohort #1; 1219, cohort #2). The median observed NB-GFR value in cohorts #1 and #2 was 73.0 ml/min/1.73 m (IQR 56.1-90.1) and 64.2 ml/min/1.73 m (IQR 49.6-83); the median predicted NB-GFR was 71.1 ml/min/1.73 m (IQR 58-81.5) and 62.6 ml/min/1.73m (IQR 47.9-75.9). The concordance line showed a slope of 0.80 and 0.86, and an intercept at 11.02 and 5.41 ml/min/1.73 m in the cohort#1 and #2, respectively. The Palacio's equation moderately over-estimated and under-estimated NB-GFR, for values below and above the cut-off of 50 ml/min/1.73 m and 35 ml/min/1.73m in cohort#1 and #2. The Lin's concordance correlation coefficient was 0.79 (95% CI 0.77-0.81) and 0.83 (95% CI 0.82-0.85).
CONCLUSIONS
We confirm the predictive performances of Palacios' equation, supporting its utilization in clinical practice.
目的
对外验证Palacios方程在评估肾癌（RCC）行部分或根治性肾切除术（PN、RN）后新的基线肾小球滤过率（NB-GFR）方面的准确性。
材料与方法
我们的研究小组最近发表了两项研究，探讨了RCC患者肾功能与癌症特异性生存之间的关联。第一项研究纳入了来自五个大型中心的3457例因cT1-2期RCC接受RN或PN手术的患者；第二项研究纳入了在一个大型中心因cT1-4期RCC接受RN或PN手术的1767例患者。从这些数据集中，使用完整的患者数据通过Palacios方程计算预测的NB-GFR：预测NB-GFR = 35.03 + 0.65×术前GFR - 18.19×（如果是根治性肾切除术） - 0.25×年龄 + 2.83×（如果肿瘤大小>7 cm） - 2.09×（如果患有糖尿病）。术后3至12个月，根据血清肌酐通过CKD-EPI方程计算观察到的NB-GFR。通过Lin一致性相关系数和Bland-Altman分析评估观察到的和预测的NB-GFR之间的一致性。
结果
共纳入2419例患者（队列1为1210例；队列2为1219例）。队列1和队列2中观察到的NB-GFR的中位数分别为73.0 ml/min/1.73m²（四分位间距56.1 - 90.1）和64.2 ml/min/1.73m²（四分位间距49.6 - 83）；预测的NB-GFR中位数分别为71.1 ml/min/1.73m²（四分位间距58 - 81.5）和62.6 ml/min/1.73m²（四分位间距47.9 - 75.9）。一致性线在队列1和队列2中的斜率分别为0.80和0.86，截距分别为11.02和5.41 ml/min/1.73m²。在队列1中，当NB-GFR值低于和高于50 ml/min/1.73m²的临界值时，以及在队列2中低于和高于35 ml/min/1.73m²的临界值时，Palacio方程对NB-GFR有适度的高估和低估。Lin一致性相关系数分别为0.79（95%CI 0.7
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