摘要
目的探讨后腹腔镜肾部分切除术(RLPN)治疗肾癌的疗效及Klotho、白蛋白/碱性磷酸酶比值(AAPR)、全身炎症反应指数(SIRI)对预后的预测价值。方法研究对象选自在宁波市医疗中心李惠利医院接受治疗的肾癌患者,共纳入202例,病例纳入年限为2019年1月至2021年10月,所有患者均给予RLPN,其中有4例失访,最终根据术后3年随访结果(随访截至2024年10月或死亡)分为预后不良组(52例)和预后良好组(146例)。统计所有患者围术期指标,术前、术后3个月的肾功能指标及随访期间的并发症,比较两组临床资料及Klotho、AAPR、SIRI,分别采用多因素logistic回归分析法和受试者工作特征曲线分析危险因素和预测价值。结果行RLPN的肾癌患者术中出血量为(94.76±27.54)mL、术后引流量(153.65±13.54)mL、手术时间(111.76±10.65)min、肠道功能恢复时间(11.65±1.76)h、肾热缺血时间(18.65±3.76)min、住院时间(7.02±1.76)d。术前、术后3个月的肾功能指标比较,差异无统计学意义(P>0.05)。随访期间,并发症发生率为4.04%。预后不良组有肿瘤家族史、肿瘤直径>3 cm、有转移的患者占比分别为55.77%、71.15%、71.15%,高于预后良好组的39.73%、26.71%、42.47%;肾动脉阻断时间长于预后良好组(P<0.05)。相比于预后良好组,预后不良组血清Klotho、AAPR均更低,SIRI更高(P<0.05)。多因素logistic回归分析结果显示,有转移(OR=2.385)、肾动脉阻断时间长(OR=2.032)、血清Klotho低(OR=3.102)、血清AAPR低(OR=2.442)、SIRI高(OR=2.965)是行RLPN的肾癌患者预后不良的独立危险因素(P<0.05)。将预后不良纳入阳性,预后良好纳入阴性,Klotho、AAPR、SIRI及联合检测预测行RLPN术的肾癌患者预后的曲线下面积(AUC)分别为0.774、0.750、0.744、0.927,灵敏度分别为73.08%、73.08%、67.31%、86.54%,特异度分别为74.66%、69.18%、71.92%、89.04%,其中联合检测的AUC最高(P<0.05)。结论RLPN治疗肾癌的创伤较小,术后恢复较快,安全性高,且对患者肾功能无明显影响,行RLPN的肾癌患者预后不良的独立危险因素包括有转移、肾动脉阻断时间长、血清Klotho低、血清AAPR低、SIRI高,其中Klotho、AAPR、SIRI联合检测对患者预后的预测作用较高。
Objective To explore the efficacy of retroperitoneal laparoscopic partial nephrectomy(RLPN)in the treatment of renal cell carcinoma and the predictive value of Klotho,albumin/alkaline phosphatase ratio(AAPR),and systemic inflammatory response index(SIRI)for prognosis.Methods The research subjects were selected from 202 patients with renal cell carcinoma receiving treatment in Ningbo Medical Center Li Huili Hospital,with a total inclusion period from January 2019 to October 2021.All patients underwent RLPN,and 4 of them were lost to follow-up.Finally,based on the 3-year follow-up results(up to October 2024 or death),they were divided into the poor prognosis group(52 cases)and the good prognosis group(146 cases).All patients'perioperative indicators,renal function indicators before and 3 months after surgery,and complications during follow-up were counted,and the clinical data and Klotho,AAPR,and SIRI of the two groups were compared.Multivariate logistic regression analysis and receiver operating characteristic curve were used to analyze risk factors and predictive value,respectively.Results The intraoperative blood loss of patients with renal cell carcinoma undergoing RLPN was(94.76±27.54)mL,postoperative drainage volume was(153.65±13.54)mL,operation time was(111.76±10.65)min,recovery time of intestinal function was(11.65±1.76)h,renal warm ischemia time was(18.65±3.76)min,and hospitalization time was(7.02±1.76)d.There was no statistically significant difference in renal function indicators before and 3 months after surgery(P>0.05).During the follow-up period,the incidence of complications was 4.04%.The proportion of patients with a family history of tumors,tumor diameter>3 cm,and metastasis in the poor prognosis group were 55.77%,71.15%,and 71.15%,respectively,which were higher than those in the good prognosis group(39.73%,26.71%,and 42.47%).The renal artery occlusion time was longer than that in the good prognosis group(P<0.05).Compared with the good prognosis group,the levels of serum Klotho and AAPR in the poor prognosis group were lower,while SIRI level was higher(P<0.05).The results of multivariate logistic regression analysis showed that metastasis(OR=2.385),long renal artery occlusion time(OR=2.032),low serum Klotho(OR=3.102),low serum AAPR(OR=2.442),and high SIRI(OR=2.965)were independent risk factors for poor prognosis in patients with renal cell carcinoma undergoing RLPN(P<0.05).The areas under the curve(AUCs)of Klotho,AAPR,SIRI,and combined detection for predicting the prognosis of patients with renal cell carcinoma undergoing RLPN were 0.774,0.750,0.744,and 0.927,with sensitivities of 73.08%,73.08%,67.31%,and 86.54%,and specificities of 74.66%,69.18%,71.92%,and 89.04%,respectively.Among them,the AUC of combined detection was the highest(P<0.05).Conclusion RLPN for renal cell carcinoma has minimal trauma,fast postoperative recovery,high safety,and no significant impact on patients'renal function.Independent risk factors for poor prognosis in patients with renal cell carcinoma undergoing RLPN include metastasis,long renal artery occlusion time,low serum Klotho,low serum AAPR,and high SIRI.The combined detection of Klotho,AAPR,and SIRI has a higher predictive effect on patient prognosis.
作者
鲁特飞
张磊
李星
LU Tefei;ZHANG Lei;LI Xing(Department of Urology,Ningbo Medical Center Li Huili Hospital,Ningbo 315040,China)
出处
《空军军医大学学报》
2025年第4期533-539,共7页
Journal of Air Force Medical University
基金
浙江省医药卫生科技计划项目(2025KY218)。
关键词
肾癌
后腹腔镜肾部分切除术
KLOTHO
白蛋白/碱性磷酸酶比值
全身炎症反应指数
预测价值
renal cell carcinoma
retroperitoneal laparoscopic partial nephrectomy
Klotho
albumin/alkaline phosphatase ratio
systemic inflammatory response index
predictive value
