Li Shijie, Chen Xiaonan, Zheng Jianyi, Liu Xuefeng
Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China.
Front Surg. 2022 Apr 25;9:872273. doi: 10.3389/fsurg.2022.872273. eCollection 2022.
To evaluate the association between perioperative estimated glomerular filtration rate (eGFR) and postoperative oncological outcomes in patients with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU),and to evaluate the effect of sex on this association.
The medical records of patients with UTUC who underwent RNU between January 2012 and December 2017 at our hospital were retrospectively reviewed. Patients were divided into three groups based on preoperative eGFRs: normal eGFR (>60 mL/min/1.73 m; = 179), moderately reduced eGFR (45-60 mL/min/1.73 m; = 45), and severely reduced eGFR (≤ 45 mL/min/1.73 m; = 36). Statistical analyses were performed to evaluate the prognostic impact of preoperative eGFR on prognosis.
Patient mean age was 66.7 ± 9.6 years, and 47.9% were female. Multivariate regression analysis based on Cox proportional risk models and Kaplan-Meier survival rates showed that lower preoperative eGFR was associated with decreased OS, PFS, and CSS. In the adjusted Cox regression model, patients with normal and moderately reduced eGFRs had a decreased hazard for mortality, with adjusted hazard ratios of 0.13 [95% confidence interval (CI): 0.07-0.26] and 0.36 (95% CI: 0.18-0.73), respectively ( < 0.001). The smooth fitting curve suggested a linear relationship between eGFR and prognostic survival. Additionally, sensitivity subgroup analyses verified an inverse relationship between the reduced eGFR and OS. Women had a lower eGFR and worse oncological outcomes than men. A nomogram for OS was developed based on multivariate analysis with a C-index of 0.754 (95% CI: 0.728-0.779).
Preoperative renal insufficiency is strongly associated with a higher risk of cancer progression and a lower survival probability. It is important to identify preoperative renal insufficiency in patients with UTUC, particularly female patients.
评估接受根治性肾输尿管切除术（RNU）治疗的上尿路尿路上皮癌（UTUC）患者围手术期估计肾小球滤过率（eGFR）与术后肿瘤学结局之间的关联，并评估性别对这种关联的影响。
回顾性分析2012年1月至2017年12月在我院接受RNU的UTUC患者的病历。根据术前eGFR将患者分为三组：正常eGFR（>60 mL/min/1.73 m²；n = 179）、中度降低的eGFR（45 - 60 mL/min/1.73 m²；n = 45）和严重降低的eGFR（≤45 mL/min/1.73 m²；n = 36）。进行统计分析以评估术前eGFR对预后的影响。
患者平均年龄为66.7±9.6岁，47.9%为女性。基于Cox比例风险模型和Kaplan-Meier生存率的多变量回归分析表明，术前eGFR较低与总生存期（OS）、无进展生存期（PFS）和癌症特异性生存期（CSS）降低相关。在调整后的Cox回归模型中，eGFR正常和中度降低的患者死亡风险降低，调整后的风险比分别为0.13[95%置信区间（CI）：0.07 - 0.26]和0.36（95%CI：0.18 - 0.73）（P < 0.001）。平滑拟合曲线表明eGFR与预后生存之间存在线性关系。此外，敏感性亚组分析证实eGFR降低与OS呈负相关。女性的eGFR低于男性，肿瘤学结局也更差。基于多变量分析开发了OS列线图，C指数为0.754（95%CI：0.728 - 0.779）。
术前肾功能不全与癌症进展风险较高和生存概率较低密切相关。识别UTUC患者，尤其是女性患者的术前肾功能不全很重要。
