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首页> 外文期刊>BJU international >Preoperative predictors of renal function decline after radical nephroureterectomy for upper tract urothelial carcinoma
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Preoperative predictors of renal function decline after radical nephroureterectomy for upper tract urothelial carcinoma

机译：根治性肾切除术治疗上尿路尿路上皮癌后肾功能下降的术前预测指标

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Objectives To model renal function after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). To identify predictors of renal function decline after surgery, thereby allowing the identification of patients likely to be ineligible for cisplatin-based chemotherapy in the adjuvant setting. Patients and Methods We retrospectively identified 374 patients treated with RNU for UTUC at three centres between 1995 and 2010. Estimated glomerular filtration rate (eGFR) was calculated using Chronic Kidney Disease Epidemiology Collaboration equation before RNU and at early (1-5 months after RNU) and late (5 months) time points after RNU. Only patients deemed eligible for cisplatin-based chemotherapy before RNU (preoperative glomerular filtration rate [GFR] ≥60 mL/min/1.73 m2) were included. Multivariable analysis identified the preoperative predictors of eGFR after RNU at early postoperative and late postoperative time points. Results A total of 163 patients had an eligible early post-RNU eGFR measurement and 172 had an eligible late eGFR measurement. The median eGFR declined by 32% and did not show a significant trend toward recovery over time (P = 0.4). On multivariable analysis preoperative eGFR and patient age were significantly associated with early and late postoperative eGFR, while Charlson comorbidity index score was significantly associated with late postoperative eGFR alone. Conclusions In patients with normal preoperative eGFR (≥60 mL/min/1.73 m2), renal function decreases by one-third after RNU and does not show evidence of recovery over time. Elderly patients and those with pre-RNU eGFR closer to 60 mL/min/1.73 m2 (lower eGFR in the present cohort) are more likely to be ineligible for adjuvant cisplatin-based chemotherapy regimens because of renal function loss after RNU.
机译：目的对上路尿路上皮癌（UTUC）进行根治性肾切除术（RNU）后的肾功能模型。为了确定手术后肾功能下降的预测因素，从而可以确定在辅助治疗中可能不适合进行基于顺铂化疗的患者。患者和方法我们回顾性鉴定了1995年至2010年间在三个中心接受374例RNU UTUC治疗的374例患者。估计肾小球滤过率（eGFR）的方法是使用RNU之前和早期（RNU之后的1-5个月）的慢性肾脏病流行病学合作方程式和RNU之后的晚（> 5个月）时间点。仅纳入被认为在RNU之前符合顺铂化疗方案的患者（术前肾小球滤过率[GFR]≥60 mL / min / 1.73 m2）。多变量分析确定了术后早期和术后晚期RNU后eGFR的术前预测指标。结果共有163例患者进行了合格的RNU早期eGFR测量，而172例患者进行了合格的eGFR晚期测量。 eGFR中位数下降了32％，并且随着时间的推移并未显示出明显的恢复趋势（P = 0.4）。在多变量分析中，术前eGFR和患者年龄与术后早期和晚期eGFR显着相关，而Charlson合并症指数评分与术后晚期eGFR单独显着相关。结论在术前eGFR≥60 mL / min / 1.73 m2的患者中，肾功能在RNU后下降了三分之一，并且没有随时间恢复的迹象。老年患者和RNU前eGFR接近60 mL / min / 1.73 m2的患者（当前队列中eGFR较低）由于RNU后肾功能丧失而更不适合进行基于顺铂的辅助化疗方案。

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