Falkenbach Fabian, Peñaranda Natali Rodriguez, Longoni Mattia, Marmiroli Andrea, Le Quynh Chi, Catanzaro Calogero, Nicolazzini Michele, Tian Zhe, Goyal Jordan A, Puliatti Stefano, Schiavina Riccardo, Palumbo Carlotta, Musi Gennaro, Chun Felix K H, Briganti Alberto, Saad Fred, Shariat Shahrokh F, Budäus Lars, Graefen Markus, Karakiewicz Pierre I
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
Martini-Klinik Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Int J Urol. 2025 Jun;32(6):710-717. doi: 10.1111/iju.70038. Epub 2025 Mar 14.
Radical prostatectomy (RP) may be a treatment option for prostate cancer in patients with chronic kidney disease (CKD). However, the effect of CKD on adverse in-hospital outcomes after RP is not well known.
Descriptive analyses, propensity score matching (PSM), and multivariable logistic and Poisson regression models were used to address National Inpatient Sample RP patients between 2005 and 2019. CKD severity was stratified as mild (stage I/II) versus moderate (stage III) versus severe (stage IV/V).
Of 191 050 RP patients, 4349 (2.3%) had CKD. Of those, 2301 (52.9%), 1416 (32.6%), and 632 (14.5%) were classified as mild, moderate, or severe CKD, respectively. The CKD rate increased from 0.3% to 5.6% (2005-2019, EAPC: + 15.3%, p < 0.001). CKD patients invariably exhibited higher rates of adverse in-hospital outcomes, except for in-hospital mortality. The absolute differences were largest for overall complications (+ 12.5%), length of stay > 2 days (+ 11.8%), and blood transfusions (+ 3.7%, all p < 0.001). CKD was an independent predictor in all comparisons except for in-hospital mortality (p < 0.05). The detrimental effect was most pronounced for dialysis for acute kidney failure (multivariable odds ratio [OR] 10.49), genitourinary complications (OR: 2.47), and critical care therapies (OR: 2.45, all p < 0.001). Finally, a dose-response relationship of CKD severity (mild vs. moderate vs. severe) and its effect on adverse in-hospital outcomes was observed in seven of 14 comparisons.
CKD patients invariably exhibited higher rates of adverse in-hospital outcomes after RP. The presence of CKD should be carefully considered when RP represents a management option.
根治性前列腺切除术（RP）可能是慢性肾脏病（CKD）患者前列腺癌的一种治疗选择。然而，CKD对RP术后不良院内结局的影响尚不清楚。
采用描述性分析、倾向评分匹配（PSM）以及多变量逻辑回归和泊松回归模型，对2005年至2019年间全国住院患者样本中的RP患者进行分析。CKD严重程度分为轻度（I/II期）、中度（III期）和重度（IV/V期）。
在191050例RP患者中，4349例（2.3%）患有CKD。其中，分别有2301例（52.9%）、1416例（32.6%）和632例（14.5%）被分类为轻度、中度或重度CKD。CKD发生率从0.3%增至5.6%（2005 - 2019年，EAPC：+15.3%，p < 0.001）。除院内死亡率外，CKD患者不良院内结局的发生率始终较高。总体并发症（+12.5%）、住院时间>2天（+11.8%）和输血（+3.7%，均p < 0.001）的绝对差异最大。除院内死亡率外，CKD在所有比较中均为独立预测因素（p < 0.05）。对急性肾衰竭透析（多变量优势比[OR] 10.49）、泌尿生殖系统并发症（OR：2.47）和重症监护治疗（OR：2.45，均p < 0.001）的有害影响最为明显。最后，在14项比较中的7项中观察到CKD严重程度（轻度与中度与重度）与其对不良院内结局影响的剂量反应关系。
CKD患者RP术后不良院内结局的发生率始终较高。当RP作为一种治疗选择时，应仔细考虑CKD的存在情况。
