Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
Department of Urology, Molecular Oncology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
BJU Int. 2024 Aug;134(2):219-228. doi: 10.1111/bju.16300. Epub 2024 Feb 14.
To rigorously evaluate the impact of the percentage of parenchymal volume preserved (PPVP) and how well the preserved parenchyma recovers from ischaemia (Rec) on functional outcomes after partial nephrectomy (PN) using an accurate and objective software-based methodology for estimating parenchymal volumes and split renal function (SRF). A secondary objective was to assess potential predictors of the PPVP.
A total of 894 PN patients with available studies (2011-2014) were evaluated. The PPVP was measured from cross-sectional imaging at ≤3 months before and 3-12 months after PN using semi-automated software. Pearson correlation evaluated relationships between continuous variables. Multivariable linear regression evaluated predictors of ipsilateral glomerular filtration rate (GFR) preserved and the PPVP. Relative-importance analysis was used to evaluate the impact of the PPVP on ipsilateral GFR preserved. Rec was defined as the percentage of ipsilateral GFR preserved normalised by the PPVP.
The median tumour size and R.E.N.A.L. nephrometry score were 3.4 cm and 7, respectively. In all, 49 patients (5.5%) had a solitary kidney. In all, 538 (60%)/251 (28%)/104 (12%) patients were managed with warm/cold/zero ischaemia, respectively. The median pre/post ipsilateral GFRs were 40/31 mL/min/1.73 m, and the median (interquartile range [IQR]) percentage of ipsilateral GFR preserved was 80% (71-88%). The median pre/post ipsilateral parenchymal volumes were 181/149 mL, and the median (IQR) PPVP was 84% (76-92%). In all, 330 patients (37%) had a PPVP of <80%, while only 34 (4%) had a Rec of <80%. The percentage of ipsilateral GFR preserved correlated strongly with the PPVP (r = 0.83, P < 0.01) and loss of parenchymal volume accounted for 80% of the loss of ipsilateral GFR. Multivariable analysis confirmed that the PPVP was the strongest predictor of ipsilateral GFR preserved. Greater tumour size and endophytic and nearness properties of the R.E.N.A.L. nephrometry score were associated with a reduced PPVP (all P ≤ 0.01). Solitary kidney and cold ischaemia were associated with an increased PPVP (all P < 0.05).
A reduced PPVP predominates regarding functional decline after PN, although a low Rec can also contribute. Tumour-related factors strongly influence the PPVP, while surgical efforts can improve the PPVP as observed for patients with solitary kidneys.
使用准确客观的基于软件的方法评估部分肾切除术 (PN) 后功能性结果的保留肾实质体积百分比 (PPVP) 和保存肾实质对缺血的恢复情况 (Rec) 的影响。次要目的是评估 PPVP 的潜在预测因素。
评估了 894 名具有可用研究（2011-2014 年）的 PN 患者。使用半自动软件，在 PN 前≤3 个月和 PN 后 3-12 个月的横截面图像上测量 PPVP。Pearson 相关性评估了连续变量之间的关系。多变量线性回归评估了同侧肾小球滤过率 (GFR) 保存和 PPVP 的预测因素。相对重要性分析用于评估 PPVP 对同侧 GFR 保存的影响。Rec 定义为同侧 GFR 保存正常化的百分比与 PPVP 之比。
肿瘤大小的中位数和 R.E.N.A.L. 肾脏测量评分分别为 3.4cm 和 7。共有 49 名患者（5.5%）有孤立肾。共有 538 名（60%）/251 名（28%）/104 名（12%）患者接受了温热/寒冷/零缺血治疗。同侧 GFR 的中位数（四分位距 [IQR]）分别为 40/31ml/min/1.73m 和 80%（71-88%）。同侧肾实质体积的中位数（IQR）分别为 181/149ml 和 84%（76-92%）。共有 330 名患者（37%）的 PPVP<80%，而只有 34 名患者（4%）的 Rec<80%。同侧 GFR 保存百分比与 PPVP 呈强相关性（r=0.83，P<0.01），肾实质体积丢失占同侧 GFR 丢失的 80%。多变量分析证实，PPVP 是同侧 GFR 保存的最强预测因素。肿瘤大小较大、内生性和 R.E.N.A.L. 肾脏测量评分的接近程度与 PPVP 降低有关（均 P≤0.01）。孤立肾和冷缺血与 PPVP 增加有关（均 P<0.05）。
PN 后功能下降主要与 PPVP 降低有关，尽管低 Rec 也可能有贡献。与肿瘤相关的因素强烈影响 PPVP，而手术努力可以提高 PPVP，正如孤立肾患者所见。
