Abstract：
BACKGROUND: Deterioration of renal function is associated with increased all-cause mortality. In renal masses larger than 4 cm, whether partial versus radical nephrectomy (PN vs. RN) might affect long-term functional outcomes is unknown. This study tested the association between PN versus RN and postoperative acute kidney injury (AKI), recovery of at least 90% of the preoperative estimated glomerular filtration rate (eGFR) at 1 year, upstaging of chronic kidney disease (CKD) one stage or more at 1 year, and eGFR decline of 45 ml/min/1.73 m2 or less at 1 year.
METHODS: Data from 23 high-volume institutions were used. The study included only surgically treated patients with single, unilateral, localized, clinical T1b-2 renal masses. Multivariable logistic regression analyses were performed.
RESULTS: Overall, 968 PN patients and 325 RN patients were identified. The rate of AKI was lower in the PN versus the RN patients (17% vs. 58%; p < 0.001). At 1 year after surgery, for the PN versus the RN patients, the rate for recovery of at least 90% of baseline eGFR was 51% versus 16%, the rate of CKD progression of ≥ 1 stage was 38% versus 65%, and the rate of eGFR decline of 45 ml/min/1.73 m2 or less was 10% versus 23% (all p < 0.001). Radical nephrectomy independently predicted AKI (odds ratio [OR], 7.61), 1-year ≥ 90% eGFR recovery (OR, 0.30), 1-year CKD upstaging (OR, 1.78), and 1-year eGFR decline of 45 ml/min/1.73 m2 or less (OR, 2.36) (all p ≤ 0.002).
CONCLUSIONS: For cT1b-2 masses, RN portends worse immediate and 1-year functional outcomes. When technically feasible and oncologically safe, efforts should be made to spare the kidney in case of large renal masses to avoid the hazard of glomerular function loss-related mortality.
METHODS: Data from 23 high-volume institutions were used. The study included only surgically treated patients with single, unilateral, localized, clinical T1b-2 renal masses. Multivariable logistic regression analyses were performed.
RESULTS: Overall, 968 PN patients and 325 RN patients were identified. The rate of AKI was lower in the PN versus the RN patients (17% vs. 58%; p < 0.001). At 1 year after surgery, for the PN versus the RN patients, the rate for recovery of at least 90% of baseline eGFR was 51% versus 16%, the rate of CKD progression of ≥ 1 stage was 38% versus 65%, and the rate of eGFR decline of 45 ml/min/1.73 m2 or less was 10% versus 23% (all p < 0.001). Radical nephrectomy independently predicted AKI (odds ratio [OR], 7.61), 1-year ≥ 90% eGFR recovery (OR, 0.30), 1-year CKD upstaging (OR, 1.78), and 1-year eGFR decline of 45 ml/min/1.73 m2 or less (OR, 2.36) (all p ≤ 0.002).
CONCLUSIONS: For cT1b-2 masses, RN portends worse immediate and 1-year functional outcomes. When technically feasible and oncologically safe, efforts should be made to spare the kidney in case of large renal masses to avoid the hazard of glomerular function loss-related mortality.
摘要：
背景：肾功能恶化与全因死亡率增加相关。在大于4厘米的肾脏肿块中，肾部分切除术与根治性切除术（PN与RN)可能影响长期功能结果未知。这项研究测试了PN和RN与术后急性肾损伤（AKI）之间的关系。恢复至少90%的术前估计肾小球滤过率（eGFR）在1年，慢性肾脏病（CKD）在1年的一个阶段或更多的分期，1年时eGFR下降45ml/min/1.73m2或更少。
方法：使用来自23个高容量机构的数据。该研究仅包括手术治疗的患者，单边,局部化,临床T1b-2肾肿块。进行多变量逻辑回归分析。
结果：总体而言，确定了968例PN患者和325例RN患者。PN与RN患者的AKI发生率较低(17%与58%；p<0.001)。手术后1年,对于PN与RN患者，基线eGFR至少90%的回收率为51%对16%，CKD进展≥1期的比率为38%对65%,eGFR下降45ml/min/1.73m2或更低的速率为10％对23％（所有p<0.001）。根治性肾切除术独立预测AKI(比值比[OR]，7.61),1年≥90%eGFR恢复(或，0.30),1年CKD升级(或，1.78),和1年eGFR下降45毫升/分钟/1.73平方米或更小(OR，2.36)(所有p≤0.002)。
结论：对于cT1b-2质量，RN预示着更糟糕的即时和1年功能结果。在技术上可行且肿瘤安全的情况下，在肾脏肿块较大的情况下，应努力保留肾脏，以避免肾小球功能丧失相关死亡的危险。
方法：使用来自23个高容量机构的数据。该研究仅包括手术治疗的患者，单边,局部化,临床T1b-2肾肿块。进行多变量逻辑回归分析。
结果：总体而言，确定了968例PN患者和325例RN患者。PN与RN患者的AKI发生率较低(17%与58%；p<0.001)。手术后1年,对于PN与RN患者，基线eGFR至少90%的回收率为51%对16%，CKD进展≥1期的比率为38%对65%,eGFR下降45ml/min/1.73m2或更低的速率为10％对23％（所有p<0.001）。根治性肾切除术独立预测AKI(比值比[OR]，7.61),1年≥90%eGFR恢复(或，0.30),1年CKD升级(或，1.78),和1年eGFR下降45毫升/分钟/1.73平方米或更小(OR，2.36)(所有p≤0.002)。
结论：对于cT1b-2质量，RN预示着更糟糕的即时和1年功能结果。在技术上可行且肿瘤安全的情况下，在肾脏肿块较大的情况下，应努力保留肾脏，以避免肾小球功能丧失相关死亡的危险。
