| Background:Renal cell carcinoma(RCC)is a highly malignant tumor in the urinary system and one of the most common tumors.Its incidence is increasing year by year,and it has seriously threatened human health.Due to the high resistance of renal cell carcinoma to radiation therapy,chemotherapy and hormone therapy,surgical treatment is currently the preferred method of renal cell carcinoma and the only method that can cure renal cell carcinoma.In recent years,radical nephrectomy(RN)has been used as a standard treatment for renal cell carcinoma,and good progress has been made in tumor efficacy.However,with the passage of time,more and more attention has been paid to the changes in renal function of healthy kidneys.There are different conclusions about whether it is gradually improved or damaged.At the same time,many clinical prognostic factors such as age,diabetes,and hypertension have an impact on renal function The impact is unknown.Therefore,research on whether renal cell carcinoma patients undergo radical nephrectomy and how renal nephrectomy affects kidney function is still under continuous research and explorationObjective:The outcome of renal function in patients with unilateral nephrectomy is still unclear.This article aims to explore the changes of renal function in patients with renal cell carcinoma after unilateral nephrectomy,and to find the predictive indexes of postoperative renal function changes.Methods:This article retrospectively analyzed unilateral nephrectomy for renal malignancies in our hospital from January 2013 to September 2018.The estimated glomerular filtration rate(eGFR)? 60ml before surgery/min·1.73m2.The clinical data of patients with pathological diagnosis of primary renal cancer after follow-up for more than 3 months,including general preoperative data,biochemical indicators and follow-up results,were used to analyze the changes of renal function after operation.The selected patients were grouped according to the eGFR index at the last follow-up.They were divided into renal insufficiency group(eGFR<60ml/min·1.73m2)and good renal function group(eGFR?60ml/min·1.73m2).There were 32 influencing factors such as age classification,gender,whether combined with hypertension and diabetes,preoperative eGFR,preoperative urine osmotic pressure,and tumor diameter.Observe and record the changes of eGFR,use a variety of single factors and multiple factors to analyze the correlation between postoperative patients' eGFR and preoperative main indicators,draw ROC curves for diagnostic value analysis,etc.Results:1.Differences of main indexes before operation of renal insufficiency group and good renal function group:Of the 119 patients selected,74 were male and 45 were female,with an average age of 60.5 ± 15.3 years.Follow-up was 3 to 60 months,with an average follow-up of 41 months.There were no statistically significant differences between the two groups in terms of gender,whether they had hypertension and diabetes,hemoglobin,red blood cell count,and platelet count.There were statistically significant differences in age,preoperative urine osmotic pressure,urea,creatinine,cystatin C,maximum tumor diameter,and preoperative eGFR(P<0.05).The age of the good renal function group(57.25±11.07 years old)was significantly lower than that of the renal insufficiency group(62.90±12.86 years old).The difference in renal function between patients older than and younger than 65 years was analyzed,and it was found that patients older than 65 years were 56.86%(21/37)Renal insufficiency occurred during the postoperative follow-up,and 32.93%(27/82)of patients under the age of 65 occurred during the postoperative follow-up.The preoperative mean creatinine in the group with good renal function was lower than that in the group with renal insufficiency.The maximum diameter of the tumor before operation was significantly higher in the renal function group than in the renal insufficiency group,and the difference was significant(P<0.05).2.The relationship between preoperative clinical indicators and the progression of renal function:multivariate logistic regression analysis,the results showed that the preoperative urine osmotic pressure and preoperative eGFR were significantly correlated with postoperative renal function deterioration.Osmotic pressure index is an independent risk factor that affects the disease.There is a negative correlation between eGFR before surgery and whether renal function worsens after surgery3.Survival analysis:The Kaplan-Meier survival curve was used for the main factors that may affect the progression of renal function after surgery.The median progression-free survival time for this group of patients was 41.00 months,and the 2-year non-progression rate was 66.9%.The 3-year unprogressed rate was 51.5%.The three-year unprogressed rate of patients under 50 years was 50.9%,while the three-year unprogressed rate of patients over 65 years was only 34.9%.Univariate analysis showed that the lymphocyte absolute value,serum creatinine,preoperative eGFR,and preoperative urine osmotic pressure had significant effects on the patient's progression rate(P<0.05).Multi-element Cox regression analysis showed that there was a significant correlation between the absolute value of lymphocytes,preoperative eGFR,and the progression of postoperative renal function deterioration(P<0.05)Hyperuricemia is also an important factor in the progression of renal function.This group of studies found that patients with low blood uric acid before surgery((?)428 ?mol/L)had a three-year progression-free survival rate of 58.3%,while patients with hyperuricemia(>428 ? mol/L)the three-year progression-free rate was only 20.4%,but it was not statistically significant(P=0.066)4.ROC curve analysis:In order to further obtain the diagnostic value of preoperative urine osmotic pressure,lymphocyte absolute value,preoperative eGFR and other three indicators for postoperative renal deterioration,select ROC curve analysis,both preoperative urine osmotic pressure and preoperative eGFR can be used as evaluation indicators for the diagnosis of postoperative renal function deterioration(AUC>0.6),and the preoperative eGFR diagnosis is better than the preoperative urine osmotic pressure index.The absolute lymphocyte index was not effective in diagnosing the deterioration of renal function after operation(AUC<0.6)Conclusions:Patients with nephrectomy for renal cell carcinoma without chronic kidney disease before surgery have a greater risk of decreased renal function after age Postoperative renal function and preoperative urine have no effect on gender and blood glucose.Osmotic pressure and preoperative eGFR are closely related and can be used as predictive indicators.The absolute value of preoperative lymphocytes and eGFR have significant effects on the rate of renal function progression.Preoperative blood uric acid level also has a certain effect on the progress of renal function,but further observation is needed. |
PDF Full Text Request