Yun-Chu Chang¹、Tzu-Ping Lin^1,3,4、Wen-Chin Chiu¹、Feng-Chu Huang¹、Yen-Hwa Chang^1,3,4、

Hsiao-Jen Chung^1,3,4、Eric YH Huang^1,3,4、Chi-Chieh Lin^1,3,4、I-shen Huang^1,3,4、

Yuan-Hwa Chou²、William J.S. Huang^1,3,4、Alex T.L. Lin^1,3,4

¹ Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan,

²Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan,

³ School of Medicine, National Yang-Ming University, Taipei, Taiwan;

⁴Shu-Tien Urological Research Center, Taipei, Taiwan

    腎臟功能受損與精神狀態變化的連續性分析

張雲筑¹、林子平^1,3,4、邱文靜¹、黃鳳珠¹、張延驊^1,3,4、鍾孝仁^1,3,4、

黃逸修^1,3,4、林志杰^1,3,4、黃奕燊^1,3,4、周元華²、黃志賢^1,3,4、林登龍^1,3,4

台北榮民總醫院泌尿部¹,台北榮民總醫院精神部²,

國立陽明大學 醫學院 泌尿學科³ ; 書田泌尿科學研究中心

 

 

Quality of life(QOL) has became a major concern because many reports suggest an comparable oncological outcome between the nephron-sparing surgery ( NSS ) and radical nephrectomy ( RN ). However, there lacks literature studying the serial psychological behavior correlated with renal function loss.

We prospectively recruited newly diagnosed renal tumor and upper tract urothelial carcinoma patients who received curative operation ( NSS or RN for renal tumor and radical nephroureterectomy with bladder cuff excision for UTUC) between November 2014 and March 2017. All patients completed pre-operative, post-operative 3 month, post-operative 6 month and post-operative 12 month questionnaires including Beck Anxiety Inventory, Beck Depression Inventory-II and EORTC QLQ-C30 (version 3) Chinese version and blood test for eGFR level.

A total of 108 patients were enrolled with 17% drop out rate. 64 renal tumor and 37 upper tract urothelial carcinoma patients were recruited. 50 patients received NSS and 51 patients received RN. 54 patients were male( 53.5% ). The mean age at surgery was 61.3 ± 16.6 years and average BMI was 24.9 ± 5.3 kg/m². The eGFR level were poorer in RN and UTUC group pre-operatively. These discrepancies persisted in the post-op 3month to 12 month follow-up. Besides, only the NSS group showed no renal function deterioration post-operatively. In NSS, RN and renal tumor groups, general psychological improvements after the operation were found while UTUC group showed poorer post-operative 3 month physical function, severer dyspnea, insomnia, constipation, and diarrhea. In RN group, The depressive mood was more evident than NSS group after operation till post-op 12 months, and showed persistent severer fatigue and dyspnea symptom. Poorer depressive mood, global health, function domains and symptom domains were noted at the post-op 3 months UTUC group compared with renal tumor group. The total eGFR level was correlated with function domains in serial follow-up, but this correlation was not seen in each tumor type or nephrectomy method. In subgroup analysis, patients with poor pre-op eGFR level ( <60 mL/min/1.73m²) showed no difference in psychological behavior with intact pre-op eGFR level.

    This is the first prospective study examing the correlation between the serial psychological behavior and the renal function loss after radical nephrectomy or nephron-sparing surgery. Depressive mood, fatigue and dyspnea were severer in RN group from pre-op stage to post-op 12 months, but the difference could not be explained by the evident renal function loss in RN group.