Bigot Pierre, Bernhard Jean-Christophe, Khene Zine-Eddine, Dariane Charles, Lebdai Souhil, Doumerc Nicolas, Nouhaud François Xavier, Ouzaid Idir, Saulnier Patrick, Méjean Arnaud, Roupret Morgan, Bensalah Karim
Department of Urology, Angers University Hospital, Angers, France.
Department of Urology, Bordeaux University Hospital, Bordeaux, France.
BJU Int. 2023 Nov;132(5):575-580. doi: 10.1111/bju.16124. Epub 2023 Jul 26.
To evaluate prospectively the effects of surgical excision of renal tumours on blood pressure (BP).
In a multicentre prospective study, we evaluated 200 patients who underwent nephrectomy for renal tumour between 2018 and 2020 at seven departments of the French Network for Kidney Cancer, the UroCCR. All patients had localized cancer without pre-existing hypertension (HTN). Blood pressure was measured the week before nephrectomy, and at 1 month and 6 months after nephrectomy, according to the recommendations for home BP monitoring. Plasma renin was measured 1 week before surgery and 6 months after surgery. The primary endpoint was the occurrence of de novo HTN. The secondary endpoint was clinically significant increase in BP at 6 months, defined by an increase in systolic and/or diastolic ambulatory BP ≥10 mmHg or requirement for medical antihypertensive treatment.
Blood pressure and renin measurements were available for 182 (91%) and 136 patients (68%), respectively. We excluded from the analysis 18 patients who had undeclared HTN detected on preoperative measurements. At 6 months, 31 patients (19.2%) had de novo HTN and 43 patients (26.3%) had a significant increase in their BP. Type of surgery was not associated with an increased risk of HTN (21.7% partial nephrectomy [PN] vs 15.7% radical nephrectomy [RN]; P = 0.59). There was no difference between plasmatic renin levels before and after surgery (18.5 vs 16; P = 0.46). In multivariable analysis, age (odds ratio [OR] 1.07, 95% confidence interval [CI] 1.02-1.12; P = 0.03) and body mass index (OR 1.14, 95% CI 1.03-1.26; P = 0.01) were the only predictors of de novo HTN.
Surgical treatment of renal tumours is associated with significant changes in BP, with de novo HTN occurring in almost 20% of the patients. These changes are not impacted by the type of surgery (PN vs RN). Patients who are scheduled to undergo kidney cancer surgery should be informed of these findings and have their BP closely monitored after the operation.
前瞻性评估肾肿瘤手术切除对血压（BP）的影响。
在一项多中心前瞻性研究中，我们评估了2018年至2020年间在法国肾癌网络UroCCR的7个科室因肾肿瘤接受肾切除术的200例患者。所有患者均为局限性癌症，术前无高血压（HTN）。根据家庭血压监测建议，在肾切除术前1周、术后1个月和6个月测量血压。在手术前1周和术后6个月测量血浆肾素。主要终点是新发HTN的发生。次要终点是6个月时血压出现具有临床意义的升高，定义为动态收缩压和/或舒张压升高≥10 mmHg或需要进行降压药物治疗。
分别有182例（91%）和136例患者（68%）获得了血压和肾素测量值。我们从分析中排除了18例术前测量发现未申报HTN的患者。6个月时，31例患者（19.2%）出现新发HTN，43例患者（26.3%）血压显著升高。手术类型与HTN风险增加无关（部分肾切除术[PN]为21.7%，根治性肾切除术[RN]为15.7%；P = 0.59）。手术前后血浆肾素水平无差异（18.5对16；P = 0.46）。在多变量分析中，年龄（比值比[OR] 1.07，95%置信区间[CI] 1.02 - 1.12；P = 0.03）和体重指数（OR 1.14，95% CI 1.03 - 1.26；P = 0.01）是新发HTN的唯一预测因素。
肾肿瘤的手术治疗与血压的显著变化相关，近20%的患者出现新发HTN。这些变化不受手术类型（PN与RN）的影响。计划接受肾癌手术的患者应被告知这些发现，并在术后密切监测血压。
