Vejlgaard Maja, Maibom Sophia L, Stroomberg Hein V, Poulsen Alicia M, Thind Peter O, Røder Martin A, Joensen Ulla N
Department of Urology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
Department of Urology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Urology. 2022 Feb;160:147-153. doi: 10.1016/j.urology.2021.11.015. Epub 2021 Nov 24.
To evaluate long-term renal function following radical cystectomy (RC) for bladder cancer and identify risk factors associated with postoperative decline in renal function.
The study included patients who underwent RC at a single centre in Denmark between 2009 and 2019. Data was collected through national electronic medical records. Renal function was evaluated by estimated glomerular filtration rate (eGFR) using pre- and postoperative creatinine measurements. Cumulative incidence and Cox Proportional Hazards models were used to describe the loss of renal function and its association with clinicopathological variables, as well as its effect on mortality.
After exclusions, 670 patients were eligible for analyses. Median follow-up time was 6.2 years (interquartile range 4.0 -8.4). The proportion of patients with renal insufficiency (eGFR<45 mL/min) increased from 8.9% before RC to 19% 5 years after surgery. A total of 610 patients with preoperative eGFR≥45 were included in survival analyses. The absolute risk of renal function decline to CKD stage G3b or worse (eGFR<45 mL/min) was 17% (95% CI 14 -20) at 5 years postoperatively. Loss of renal function was not significantly associated with higher all-cause mortality. In multivariate analysis lower preoperative eGFR, diabetes mellitus, prior pelvic radiation therapy, continent urinary diversion types, and postoperative ureteral stricture were all independently associated with renal function decline.
The long-term renal function decreases considerably for a large number of RC patients. Recognizing preoperative risk factors could identify patients who benefit from enhanced renal surveillance or early intervention for modifiable factors to minimize renal insufficiency following RC.
评估膀胱癌根治性膀胱切除术（RC）后的长期肾功能，并确定与术后肾功能下降相关的危险因素。
该研究纳入了2009年至2019年在丹麦单一中心接受RC的患者。数据通过国家电子病历收集。使用术前和术后肌酐测量值，通过估计肾小球滤过率（eGFR）评估肾功能。采用累积发病率和Cox比例风险模型来描述肾功能丧失及其与临床病理变量的关联，以及其对死亡率的影响。
排除后，670例患者符合分析条件。中位随访时间为6.2年（四分位间距4.0 - 8.4）。肾功能不全（eGFR<45 mL/min）患者的比例从RC术前的8.9%增加到术后5年的19%。共有610例术前eGFR≥45的患者纳入生存分析。术后5年肾功能下降至慢性肾脏病G3b期或更差（eGFR<45 mL/min）的绝对风险为17%（95%CI 14 - 20）。肾功能丧失与全因死亡率升高无显著关联。多因素分析显示，术前eGFR较低、糖尿病、既往盆腔放疗、可控性尿流改道类型和术后输尿管狭窄均与肾功能下降独立相关。
大量RC患者的长期肾功能显著下降。识别术前危险因素可确定哪些患者可从强化肾脏监测或针对可改变因素的早期干预中获益，以尽量减少RC术后的肾功能不全。
