临床常用肾肿瘤评分系统预测囊性肾肿物手术结果的效果分析  

A rational analysis of the commonly used renal tumor scoring systems in predicting surgical outcomes of cystic renal masses

作　　者：陈炜 王永亮 成康 陈博宏 张盼[1] 方启翔 吴大鹏[1] Chen Wei;Wang Yongliang;Cheng Kang;Chen Bohong;Zhang Pan;Fang Qixiang;Wu Dapeng(Department of Urology,the First Affiliated Hospital of Xi′an Jiaotong University,Xi′an 710061,China;The Second Department of Surgery,Xixiang County People′s Hospital,Hanzhong 723500,China;Xi′an Jiaotong University Health Science Department,Xi′an 710061,China)

机构地区：[1]西安交通大学第一附属医院泌尿外科,西安710061 [2]陕西省西乡县人民医院外二科,汉中723500 [3]西安交通大学医学部,西安710061

出　　处：《中华医学杂志》2023年第42期3424-3430,共7页National Medical Journal of China

摘　　要：目的探讨临床常用肾肿瘤评分系统对囊性肾肿物(CRM)手术结果的预测效果。方法回顾性分析2018年1月至2020年6月在西安交通大学第一附属医院接受机器人辅助腹腔镜肾部分切除术(RAPN)治疗的234例患者资料。31例为CRM患者,203例为实性肾肿物(SRM)患者。以logistic回归模型计算患者的倾向性评分,采用最近邻法进行1∶2匹配,比较CRM组和SRM组围手术期相关指标及远期估算的肾小球滤过率(eGFR)的变化等,分别以R.E.N.A.L.评分和PADUA评分分层比较CRM组和SRM组理想手术结果达成率的差异,并分析影响理想手术结果达成的预测因素。将CRM直径以4 cm为截断值,直径<4 cm为CRM1组,直径≥4 cm为CRM2组,并与其各自匹配的SRM1组和SRM2组进行手术结果的对比分析。结果匹配后,CRM组29例,年龄为(48.7±10.8)岁,男性22例(75.9%);SRM组58例,年龄为(50.4±10.2)岁,男性41例(70.7%),差异均无统计学意义(均P>0.05)。CRM组热缺血时间[M(Q_(1),Q_(3))]长于SRM组[23(18,25)比19(17,25)min,P=0.040];手术时间[M(Q_(1),Q_(3))]长于SRM组[130(100,150)比108(86,120)min,P=0.006]。CRM组手术前后血肌酐的变化值[M(Q_(1),Q_(3))]高于SRM组[15(10,23)比12(6,17)μmol/L,P=0.030]。CRM组和SRM分别有7例(24.1%)和36例(62.1%)患者获得理想手术结果。SRM组R.E.N.A.L.评分手术中级复杂和PADUA评分手术高级复杂的理想手术结果达成例数分别为24例(58.5%)和15例(51.7%),分别高于CRM组对应的6例(27.3%)和1例(5.9%)(均P<0.05)。术前eGFR(OR=0.758,95%CI:0.719~0.799)和肿物性质(以CRM为参照,OR=4.883,95%CI:1.550~15.378)是达成理想手术结果的影响因素。亚组分析显示,CRM2组的手术前后eGFR变化值、术中出血量均大于SRM2组,热缺血时间、手术时间均长于SRM2组(均P<0.05);CRM1组术中出血量小于CRM2组,热缺血时间均短于CRM2组(均P<0.05)。结论直径≥4 cm的复杂CRM行RAPN的手术风险高于同等R.E.N.A.L.及PADUA评分的SRM。Objective To explore the predictive effect of the renal tumor scoring system on the surgical outcomes of cystic renal masses(CRM).Methods A retrospective analysis was performed on the data of 234 patients who received robotic-assisted partial nephrectomy(RAPN)treatment in the First Affiliated Hospital of Xi′an Jiaotong University from January 2018 to June 2020.And 31 cases had CRM and 203 cases had solid renal masses(SRM).The propensity score of patients was calculated by logistic regression model,and 1∶2 matching was performed by the nearest neighbor method.The changes in perioperative indexes and long-term estimated glomerular filtration rate(eGFR)in CRM group and SRM group were compared.The CRM group and SRM group were stratified according to the complexity grading of R.E.N.A.L.score and PADUA score,respectively,to compare the difference in the achievement rate of ideal surgical outcome between the two groups,and analyze the predictive factors affected.The CRM diameter was stratified with 4 cm as the cut-off value(CRM1 group with a diameter<4 cm,CRM2 group with a diameter≥4 cm),and the surgical results were compared with the matched SRM1 group and SRM2 group.Results In the matching cohort,the CRM group comprised 29 patients with a mean age of(48.7±10.8)years,of which 22(75.9%)were males.The SRM group included 58 patients with a mean age of(50.4±10.2)years,of which 41(70.7%)were males,with no statistically significant difference(all P>0.05).The warm ischemia time(WIT)[M(Q_(1),Q_(3))]in the CRM group was longer than that in the SRM group[23(18,25)vs 19(17,25)min,P=0.040].The operation time(OT)[M(Q_(1),Q_(3))]in the CRM group was also longer than that of the SRM group[130(100,150)vs 108(86,120)min,P=0.006].The change in serum creatinine before and after the operation[M(Q_(1),Q_(3))]was higher in the CRM group than in the SRM group[15(10,23)vs 12(6,17)μmol/L,P=0.030].The ideal surgical outcomes were achieved in 7 patients(24.1%)in the CRM group and 36 patients(62.1%)in the SRM group.The number of patients

关 键 词：肾肿瘤 囊性肾肿物 实性肾肿物 手术风险 肾肿瘤评分系统 倾向性评分匹配 回顾性队列研究 

分 类 号：R737.11[医药卫生—肿瘤]