Saitta Cesare, Paciotti Marco, Lughezzani Giovanni, Garofano Giuseppe, Meagher Margaret F, Yuen Kit L, Fasulo Vittorio, Contieri Roberto, Avolio Pier Paolo, Piccolini Andrea, Arena Paola, Mantovani Matilde, Beatrici Edoardo, Calatroni Marta, Reggiani Francesco, Hurle Rodolfo F, Lazzeri Massimo, Saita Alberto, Casale Paolo, Derweesh Ithaar H, Buffi Nicolò M
Department of Urology IRCCS Humanitas Research Hospital Rozzano Italy.
Biomedical Science Humanitas University Pieve Emanuele Italy.
BJUI Compass. 2024 Aug 30;5(10):942-949. doi: 10.1002/bco2.417. eCollection 2024 Oct.
The purpose of this study is to investigate the impact of Mayo Adhesive Probability (MAP) score and body mass index (BMI) on renal function decline after robotic assisted partial nephrectomy (RAPN).
We queried our prospective database for patients who underwent RAPN between January 2018 and December 2023. Outcomes were development of de novo CKD-S3 (estimated glomerular filtration rate [eGFR] < 60 ml/min/1.73 m). Multivariable analysis (MVA) via Cox regression identified predictors for CKD-S3. Kaplan-Meier Analyses was fitted for survival assessment. Finally, multivariable linear regression was utilized to identify predictors of delta eGFR at last follow-up (preoperative eGFR-last eGFR).
Two-hundred fifty-eight patients were analysed (obese = 49 [19%]; MAP score 0-2 = 135 [52.33%]; MAP score 3-5 = 123 [47.6%]) with a median follow-up of 33 (IQR 20-42) months. MVA revealed, high MAP score (HR 2.29, = 0.019), increasing RENAL score (HR 1.26, = 0.009), increasing age (HR 1.04, = 0.003), obesity (HR 2.38, = 0.006) and diabetes mellitus (HR 2.38, = 0.005) as associated with increased risk of development of CKD-S3, while trifecta achievement was not ( = 0.63). Comparing low MAP score versus high MAP score 4-year CKD-S3 free survival was 87.8% versus 56.1% ( < 0.001). Multivariable linear regression showed that high MAP score (coefficient 6.64, = 0.001) and BMI (coefficient 0.51, = 0.011) were significantly associated with increased delta eGFR at last follow up.
MAP score and increasing BMI are predictor for long term renal functional detrimental. These insights may call consideration for closer follow-up or greater medical scrutiny prior surgery in obese patients and with elevated MAP score. Further investigations are requisite.
本研究旨在探讨梅奥粘连概率（MAP）评分和体重指数（BMI）对机器人辅助部分肾切除术（RAPN）后肾功能下降的影响。
我们查询了2018年1月至2023年12月期间接受RAPN的患者的前瞻性数据库。结局指标为新发慢性肾脏病-S3（估计肾小球滤过率[eGFR]<60ml/min/1.73m²）的发生情况。通过Cox回归进行多变量分析（MVA）以确定慢性肾脏病-S3的预测因素。采用Kaplan-Meier分析进行生存评估。最后，利用多变量线性回归确定末次随访时eGFR变化量（术前eGFR-末次eGFR）的预测因素。
共分析了258例患者（肥胖患者=49例[19%]；MAP评分0-2分=135例[52.33%]；MAP评分3-5分=123例[47.6%]），中位随访时间为33（四分位间距20-42）个月。多变量分析显示，高MAP评分（风险比[HR]2.29，P=0.019）、RENAL评分增加（HR 1.26，P=0.009）、年龄增加（HR 1.04，P=0.003）、肥胖（HR 2.38，P=0.006）和糖尿病（HR 2.38，P=0.005）与慢性肾脏病-S3发生风险增加相关，而达到三连胜则无相关性（P=0.63）。比较低MAP评分与高MAP评分，4年无慢性肾脏病-S3生存率分别为87.8%和56.1%（P<0.001）。多变量线性回归显示，高MAP评分（系数6.64，P=0.001）和BMI（系数0.51，P=0.011）与末次随访时eGFR变化量增加显著相关。
MAP评分和BMI增加是长期肾功能损害的预测因素。这些见解可能促使人们考虑对肥胖患者和MAP评分升高的患者在术前进行更密切的随访或更严格的医学检查。需要进一步研究。
