Department of urology, Institute of clinical sciences, Sahlgrenska Academy, University of Gothenburg; Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Urology, Gothenburg, Sweden.
Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden.
Scand J Urol. 2024 May 15;59:109-116. doi: 10.2340/sju.v59.40322.
Several risk factors for end-stage renal disease (ESRD), in patients undergoing surgical treatment for renal cell carcinoma (RCC), have been suggested by others. This study aimed to investigate such risk factors and disclose the effect of developing ESRD, postoperatively, on overall survival. The risk of developing ESRD after RCC diagnosis was also evaluated.
The data of 16,220 patients with RCC and 162,199 controls were extracted from the Renal Cell Cancer Database Sweden, with linkages across multiple national registers between 2005 and 2020. Cox proportional hazards regression, Kaplan-Meier curves and cumulative incidence were used for statistical analysis.
The 5-year cumulative incidence of ESRD following RCC diagnosis was 2.4% (95% confidence interval [CI] 2.1-2.6) and 0.4% (95% CI 0.3-0.4) for the patients with RCC and controls, respectively. Age, chronic kidney disease, higher T-stage and radical nephrectomy (RN) were significant risk factors for ESRD within 1-year of surgery. A total of 104 and 12,152 patients with and without ESRD, respectively, survived 1-year postoperatively. The 5-year overall survival rates of patients with ESRD and those with RCC only were 50% (95% CI 0.40-0.60) and 80% (95% CI 0.80-0.81), respectively.
Patients who developed ESRD following renal cancer surgery had significantly poorer survival outcomes. Advanced age, comorbidities, higher-stage tumours and RN were identified as risk factors for developing ESRD. Surgical decisions are crucial. Efforts to spare renal function, including nephron-sparing surgery and active surveillance in appropriate cases, are highly relevant to reduce the development of severe kidney dysfunction.
已有研究提出了接受肾细胞癌（RCC）手术治疗的患者发生终末期肾病（ESRD）的多种危险因素。本研究旨在探讨这些危险因素，并揭示术后发生 ESRD 对总生存的影响。还评估了 RCC 诊断后发生 ESRD 的风险。
从瑞典肾细胞癌数据库中提取了 16220 例 RCC 患者和 162199 例对照者的数据，这些数据在 2005 年至 2020 年间通过多个国家登记处进行了链接。采用 Cox 比例风险回归、Kaplan-Meier 曲线和累积发生率进行统计学分析。
RCC 诊断后 5 年 ESRD 的累积发生率分别为 2.4%（95%可信区间[CI] 2.1-2.6）和 0.4%（95%CI 0.3-0.4），RCC 患者和对照者分别为 0.4%（95%CI 0.3-0.4）。年龄、慢性肾脏病、较高的 T 分期和根治性肾切除术（RN）是术后 1 年内发生 ESRD 的显著危险因素。分别有 104 例和 12152 例患者发生和未发生 ESRD，术后 1 年存活。发生 ESRD 的患者和仅发生 RCC 的患者的 5 年总生存率分别为 50%（95%CI 0.40-0.60）和 80%（95%CI 0.80-0.81）。
接受肾癌手术后发生 ESRD 的患者生存结局显著较差。高龄、合并症、较高分期的肿瘤和 RN 被确定为发生 ESRD 的危险因素。手术决策至关重要。为减少严重肾功能障碍的发生，努力保留肾功能，包括保肾手术和在适当情况下进行主动监测，具有重要意义。
