上泌尿道移形上皮細胞癌之病人接受腎臟輸尿管全切除手術後之腎臟功能長期變化
劉展榮 歐建慧 楊文宏
國立成功大學附設醫院泌尿部
Long term renal function following nephroureterectomy in upper urinafry tract transitional cell carcinoma: 3 years experience
Chan-Jung, Liu, Chien-Hui Ou, Wen-Horng Yang
National Cheng Kung University Hospital Department of Urology
Purpose: This study is designed to evaluate the estimated glomerular filtration rate (eGFR) changes in patients undergoing radical nephro-ureterectomy (RNU) for upper tract urothelial carcinoma (UTUC).
Materials and Methods: We retrospectively reviewed our patients with upper urinary tract TCC undergone nephroureterectomy from 2007 to 2012. Only patients with upper urinary tract transitional cell carcinoma (TCC) were enrolled in our study. We exclused the patients with end-stage-renal disease. Total 72 patients had completed follow up for three years after nephroureterectomy. The estimated glomerular filtration rate (eGFR) was calculated using the modified glomerular filtration rate estimating equation: eGFR (mL/min/1.73 m2 ) = 175 × Scr−1.234 × age−0.179 (× 0.79 if female). We compared eGFR before surgery and one year after surgery, two years after surgery, and three years after surgery.
Results: Overall 72 patients were included in the study. The median age at surgery was 66.46
(46–86) years. 31 patients (44%) had a preoperative eGFR ≧ 60 mL/min per 1.73 m2 and 53 (75%) had an eGFR ≧ 45 mL/min per 1.73 m2. The preoperative CKD stage distribution was: CKD I (n = 4, 5.5%), CKD II (n = 27, 37.5%), CKD III (n = 33, 46%), and CKD IV (n = 8, 11.1%). After RNU, 15 patients (20.8%) had a postoperative eGFR ≧ 60 mL/min per 1.73 m2 and 41 (56.9%) had an eGFR ≧ 45 mL/min per 1.73 m2. The postoperative CKD stages distribution was: CKD I (n = 1, 1%), CKD II (n = 14, 19%), CKD III (n = 46, 64%), CKD IV (n = 5, 7%) and CKD V (n = 6, 8.3%). Comparison of preoperative and postoperative Scr levels for each patient showed a mean difference of 0.44 mg/dL (P < 0.001), which represents a median (IQR) increase of 27.2%. On similar analysis performed for eGFR, we found a mean difference between preoperative and postoperative eGFR of 10.8 mL/min per 1.73 m2 (P < 0.001), which represents a median (IQR) decrease of 18.2 %. 3 years after RNU, 14 patients (19%) had a postoperative eGFR ≧ 60 mL/min per 1.73 m2 and 37 (51.4%) had an eGFR ≧ 45 mL/min per 1.73 m2. The long-term CKD stages distribution was: CKD I (n = 0, 0%), CKD II (n = 14, 19%), CKD III (n = 38, 53%), CKD IV (n = 11, 22.2%) and CKD V (n = 9, 12.5%). The eGFR decreased within years as 58.06, 47.28, 45.68, and 41.91 mL/min per 1.73 m2 (P < 0.001).
Conclusions: TCCs located in the upper urinary tract had negative impact on the ipsilateral renal function. eGFR was relatively low and furthermore, it significantly decreased within years after RNU.