Cancer UrologyCancer UrologyОнкоурология1726-97761996-1812Publishing House ABV Press37410.17650/1726-9776-2014-10-3-22-30DIAGNOSIS AND TREATMENT OF URINARY SYSTEM TUMORS. RENAL CANCERДИАГНОСТИКА И ЛЕЧЕНИЕ ОПУХОЛЕЙ МОЧЕПОЛОВОЙ СИСТЕМЫ. Рак почкиImpact of surgical volume on functional results and cardiospecific survival rates in patients with clinically localized renal cancerВлияние объема хир ургического вмешательства на функциональные результаты и кардиоспецифическую выживаемость у больных клинически локализованным раком почкиVolkovaM. I.ВолковаМ. И.
Russian Federation
mivolkova@rambler.ruSkvortsovI. Ya.СкворцовИ. Я.
Russian Federation
KlimovA. V.КлимовА. В.
Russian Federation
ChernyaevV. A.ЧерняевВ. А.
Russian Federation
KomarovM. I.КомаровМ. И.
Russian Federation
MatveevV. B.МатвеевВ. Б.
Russian Federation
PetersM. V.ПетерсМ. В.
Russian Federation
N.N. Blokhin Russian Cancer Research Center, Russian Academy of Medical Sciences, MoscowФГБУ «РОНЦ им. Н.Н. Блохина» РАМН, МоскваDepartment of Oncology, Russian Medical Academy of Postgraduate Education, Moscowкафедра онкологии ГБОУ ДПО РМАПО Минздрава России, Москва3009201410322300711201407112014https://oncourology.abvpress.ru/oncur/article/view/374

Objective: to analyze the impact of surgical volume on functional results and cardiospecific survival rates in patients with clinically localized renal carcinoma.

Subjects and methods. Four hundred and fifty-three patients with pT1–3aN0M0 renal cell carcinoma and normally functioning secondkidney who had undergone radical nephrectomy (n = 226 (49.9 %)) or kidney resection (n = 227 (50.1 %)) were selected for the investigation. The patient groups who had undergone different-volume operations were matched for gender, age, body mass index (BMI), side of involvement, tumor sizes, and baseline glomerular filtration rate (GFR) (p > for all). The median baseline Charlson index and the rate of ASA classes III–IV operative risk were significantly higher in candidates for radical nephrectomy (p < 0.05 for all), the rate of diseases affecting kidney function, pT1a category, and G1 anaplasia were higher in the kidney resection group (p < 0.0001). The median follow-up was 50 (12–224) months.

Results. Within 28 days postsurgery, the rate of acute renal dysfunction (ARD) was 36.2 %. The independent risk factors of ARD were kidney resection (risk ratio (RR) = 0.210; 95 % confidence interval (CI) 0.115–0.288; р < 0.0001) and ischemia time (RR = 0.012; 95 % CI 0.004–0.021; p = 0.004). The degree of ARD after kidney resection was significantly lower than that following radical nephrectomy (p < 0.0001). In the late postoperative period, the incidence of chronic kidney disease (CKD) Stage ≥ III was 38.4 %. Its independent risk factors were low baseline GFR (RR = 0.003; 95 % CI 0.002–0.005; p < 0.0001), radical nephrectomy (RR = 0.195; 95 % CI 0.093–0.298; p < 0.0001), and ARD (RR = 0.281; 95 % CI 0.187–0.376; p = 0.0001). Ten-year specific and cardiospecific survival rates in all the patients were 98.5 and 94.9 %, respectively, and unrelated to surgical volume. The independent predictors of poor cardiospecific survival were BMI, Charlson index, and ASA risk. No relationship was found betwen cardiospecific survival and GFR in the late postoperative period.

Conclusion. Kidney resection versus radical nephrectomy significantly increases the risk of severe ARD. The scope of surgical treatment for clinically localized renal cancer has not been found to affect cardiospecific survival.

Цель исследования – анализ влияния объема хирургического вмешательства на функциональные результаты и кардиоспецифическую выживаемость (КСВ) у больных клинически локализованным раком почки (РП).

Материалы и методы. В исследование отобрано 453 больных почечно-клеточным раком рТ1–3аN0M0 с нормально функционирующей второй почкой, подвергнутых радикальной нефрэктомии (РНЭ) (n = 226; 49,9 %) или резекции почки (n = 227; 50,1 %). Группы пациентов, подвергнутых операциям разного объема, сопоставимы по полу, возрасту, индексу массы тела (ИМТ), стороне поражения, размерам опухоли, исходной скорости клубочковой фильтрации (СКФ) (р > 0,05 для всех). Исходная медианаиндекса Чарльсона и частота операционного риска ASA III–IV были достоверно выше у кандидатов для РНЭ (p < 0,05 для всех), частота заболеваний, влияющих на функцию почек, категории рТ1а и степени анаплазии G1, – в группе резекции почки (р < 0,0001). Медиана наблюдения – 50 (12–224) мес.

Результаты. Частота острого нарушения почечной функции (ОНПФ) в течение 28 сут после операции составила 36,2 %. Независимыми факторами риска ОНПФ являлись: резекция почки (отношение шансов (ОШ) 0,210; 95 % доверительный интервал (ДИ) 0,115–0,288; р < 0,0001) и время ишемии (ОШ 0,012; 95 % ДИ 0,004–0,021; p = 0,004). Степень ОНПФ после резекции почки достоверно ниже, чем после РНЭ (р < 0,0001). Частота развития хронической болезни почек (ХБП) ≥ III стадии в позднем послеоперационном периоде составила 38,4 %. Независимыми факторами риска ХБП ≥ III стадии являлись: низкая исходная СКФ (ОШ 0,003; 95 % ДИ 0,002–0,005; p < 0,0001), РНЭ (ОШ 0,195; 95 % ДИ 0,093–0,298; p < 0,0001) и ОНПФ (ОШ 0,281; 95 % ДИ 0,187–0,376; p = 0,0001). Десятилетняя специфическая и КСВ всех больных составила 98,5 и 94,9 % соответственно и не зависела от объема хирургического вмешательства. Независимыми факторами неблагоприятного прогноза КСВ являлись ИМТ, индекс Чарльсона и риск по шкале ASA. Не выявлено зависимости КСВ от СКФ в отдаленном послеоперационном периоде.

Заключение. Резекция почки достоверно увеличивает риск ОНПФ и снижает риск тяжелой ХБП по сравнению с РНЭ. Не выявлено влияния объема хирургического лечения клинически локализованного РП на КСВ.

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