Huang Yixin, Gao Ming, Wang Yanjun, Zheng Rongliang, Yin Shaohan, Liu Huiming, Zou Xiangpeng, Luo Xin, Xiong Longbin, Zhou Zhaohui, Peng Yulu, Zhou Fangjian, Han Hui, Guo Shengjie, Dong Pei, Dong Wen, Zhang Zhiling
Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China; State Key Laboratory of Oncology in Southern China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China; State Key Laboratory of Oncology in Southern China, Guangzhou, P. R. China.
Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
Urol Oncol. 2025 Jun;43(6):394.e1-394.e8. doi: 10.1016/j.urolonc.2024.12.271. Epub 2025 Jan 10.
The assessment of split renal function (SRF) before and after partial nephrectomy (PN) is crucial. While nuclear renal scan (NRS) is a traditional method for evaluating SRF, its extensive use is hindered by concerns regarding radioactivity. Parenchymal volume analysis (PVA) has been employed to assess SRF for kidney donors. Nonetheless, the efficacy of PVA in evaluating SRF in kidneys with renal masses before and after PN with warm ischemia remains uncertain.
The current study probed into the potential of PVA as a substitute for NRS in assessing SRF before and after PN with warm ischemia.
This study included 318 patients who underwent unilateral PN with warm ischemia at Sun Yat-Sen University Cancer Center (SYSUCC) and had a functional contralateral kidney. All patients underwent PVA and NRS assessments both pre-PN and at 1-12 months post-PN. PVA was analyzed using Mimics software in the venous phase. The estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 2021 equation. The correlation between ipsilateral eGFR values derived from SRF assessed via PVA and NRS was examined using Pearson correlation. Concordance between different methods of SRF estimation was analyzed using the Friedman test, Bland-Altman plots, and Kendall's consistency coefficient. Similar study was conducted on a comparable cohort from Sun Yat-Sen Memorial Hospital.
The median tumor size was 3.5cm, and the median warm ischemia time was 25min. Preoperatively, ipsilateral SRF values based on PVA were notably consistent with those derived from NRS (49.4% vs 50.0%, P = .501). A strong correlation was observed between preoperative ipsilateral eGFR based on SRF from PVA and NRS (r = 0.89, P < .0001). Bland-Altman plots indicated minimal bias (-0.36%) between PVA and NRS in assessing SRF. However, post-PN, the median ipsilateral SRF based on PVA was slightly higher than that based on NRS (45.6% vs. 43.6%, P < .0001). Although there was still a strong correlation between post-PN ipsilateral eGFR based on SRF from PVA and NRS (r = 0.87, P < .0001), Bland-Altman plots revealed a non-negligible bias between the 2 methods (2.19 %). External study supported our findings.
PVA shows promise as a substitute for NRS in assessing SRF before PN with warm ischemia. However, this substitution may result in an overestimation of ipsilateral renal function in the post-PN phase.
评估部分肾切除术（PN）前后的分肾功能（SRF）至关重要。虽然核肾扫描（NRS）是评估SRF的传统方法，但由于对放射性的担忧，其广泛应用受到阻碍。实质体积分析（PVA）已被用于评估肾供体的SRF。然而，PVA在评估伴有肾肿块的肾脏在热缺血PN前后的SRF方面的疗效仍不确定。
本研究探讨PVA作为NRS的替代方法在评估热缺血PN前后SRF的潜力。
本研究纳入了318例在中山大学肿瘤防治中心（SYSUCC）接受单侧热缺血PN且对侧肾功能正常的患者。所有患者在PN术前及术后1 - 12个月均接受了PVA和NRS评估。在静脉期使用Mimics软件分析PVA。使用慢性肾脏病流行病学协作组（CKD - EPI）2021方程计算估计肾小球滤过率（eGFR）。采用Pearson相关性分析通过PVA和NRS评估的SRF得出的同侧eGFR值之间的相关性。使用Friedman检验、Bland - Altman图和Kendall一致性系数分析不同SRF估计方法之间的一致性。对中山大学孙逸仙纪念医院的一个可比队列进行了类似研究。
肿瘤中位大小为3.5cm，热缺血中位时间为25分钟。术前，基于PVA的同侧SRF值与基于NRS的同侧SRF值显著一致（49.4%对50.0%，P = 0.501）。基于PVA和NRS的术前同侧SRF的eGFR之间观察到强相关性（r = 0.89，P < 0.000）。Bland - Altman图显示PVA和NRS在评估SRF时偏差最小（-0.36%）。然而，PN术后，基于PVA的同侧SRF中位数略高于基于NRS的同侧SRF中位数（45.6%对43.6%，P < 0.0001）。尽管基于PVA和NRS的PN术后同侧SRF的eGFR之间仍有强相关性（r = 0.87，P < 0.0001），但Bland - Altman图显示两种方法之间存在不可忽视的偏差（2.19%）。外部研究支持了我们的发现。
在评估热缺血PN术前的SRF时，PVA有望替代NRS。然而，这种替代可能导致PN术后同侧肾功能的高估。
