Wang Haixin, Huang Haiwen, Hao Han, Xi Zhijun
Department of Urology, Peking University First Hospital, Beijing, China.
Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China.
Front Oncol. 2024 Nov 22;14:1453346. doi: 10.3389/fonc.2024.1453346. eCollection 2024.
The aim of this study was to explore the factors affecting the major complications and the impacts of preoperative renal function on the incidence of complications in radical cystectomy procedures.
A retrospective review of 705 patients who received radical cystectomy between 2006 and 2021 was conducted. The 90-day complications of patients after a radical cystectomy were reported and the Clavien-Dindo classification (CDC) was used for grading complications. The clinical characteristics and preoperative outcomes were compared among patients with different preoperative renal functions. A logistic regression analysis of all patients was used to identify the risk factors associated with the major complications. Spearman's correlation analysis was used to examine the relationship between the classification of renal insufficiency and the CDC. In order to reduce the selection bias, one-to-one propensity score matching was performed, and the comparison of complications after matching was carried out for the sensitivity analysis.
Within 90 days post-surgery, 71% of patients experienced complications, with 4.8% of them being major. Patients with preoperative renal insufficiency had a higher CDC and had a higher rate of major complications (16.7% vs 3.7%, < 0.001). There was a linear relationship between preoperative serum creatinine and complications. Spearman's correlation analysis showed a slightly positive correlation between the classification of renal insufficiency and the CDC (r=0.094, = 0.013). Preoperative renal insufficiency was a risk factor for major complications (OR = 6.805 [95%CI: 2.706-17.112]; < 0.001). After matching, the patients in the preoperative renal insufficiency group had a higher CDC and a higher incidence of major complications (16.9% vs 1.7%, p = 0.004).
In our cohort, patients with preoperative renal insufficiency exhibited a higher incidence of complications following a radical cystectomy, and renal insufficiency was a significant risk factor for major complications.
本研究旨在探讨影响根治性膀胱切除术主要并发症的因素以及术前肾功能对并发症发生率的影响。
对2006年至2021年间接受根治性膀胱切除术的705例患者进行回顾性研究。报告患者根治性膀胱切除术后90天的并发症情况，并采用Clavien-Dindo分类（CDC）对并发症进行分级。比较不同术前肾功能患者的临床特征和术前结果。对所有患者进行逻辑回归分析，以确定与主要并发症相关的危险因素。采用Spearman相关性分析来检验肾功能不全分级与CDC之间的关系。为减少选择偏倚，进行一对一倾向评分匹配，并对匹配后的并发症情况进行比较以进行敏感性分析。
术后90天内，71%的患者出现并发症，其中4.8%为主要并发症。术前肾功能不全患者的CDC更高，主要并发症发生率也更高（16.7%对3.7%，<0.001）。术前血清肌酐与并发症之间存在线性关系。Spearman相关性分析显示肾功能不全分级与CDC之间存在轻度正相关（r = 0.094，= 0.013）。术前肾功能不全是主要并发症的危险因素（OR = 6.805 [95%CI：2.706 - 17.112]；<0.001）。匹配后，术前肾功能不全组患者的CDC更高，主要并发症发生率也更高（16.9%对1.7%，p = 0.004）。
在我们的队列中，术前肾功能不全的患者在根治性膀胱切除术后并发症发生率更高，肾功能不全是主要并发症的重要危险因素。
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