Systematic classification and prediction of complications after nephrectomy in patients with metastatic renal cell carcinoma (RCC).
Systematic classification and prediction of complications after nephrectomy in patients with metastatic renal cell carcinoma (RCC).
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DOI：
10.1111/j.1464-410x.2012.11103.x
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发表时间：
2012-11
影响因子：
4.5
通讯作者：
Russo P
中科院分区：
文献类型：
--
作者：
Silberstein JL;Adamy A;Maschino AC;Ehdaie B;Garg T;Favaretto RL;Ghoneim TP;Motzer RJ;Russo P
评估和确定转移性肾细胞癌（mRCC）患者根治性肾切除术后发病率的预测因素。我们确定了1989年至2009年间在纪念斯隆-凯特琳癌症中心（MSKCC）接受肾切除术的mRCC患者。术后并发症的特征采用改良版的Clavien-Dindo分类系统。患者和疾病特征，包括先前验证的MSKCC风险分层系统，使用钙、血红蛋白（Hb）、乳酸脱氢酶和Karnofsky性能状态（KPS），使用单变量和多变量logistic回归模型评估作为术后并发症的预测因素。计算每个模型的受试者工作特征曲线（AUC）下的面积，以评估预测准确性，并使用10倍交叉验证对过拟合进行校正。在研究期间，195名mRCC患者接受了肾切除术；53例（27%）在手术8周内出现≥2级并发症。肺、血栓栓塞事件和需要输血的贫血是转移性肾切除术后最常见的并发症。在单因素分析中，年龄、低白蛋白、低KPS、高校正血清钙、低血清Hb和不利的MSKCC风险评分是并发症的预测因素。术后并发症患者在56天内接受全身治疗的可能性较小（优势比[OR] 0.32； 95%可信区间[CI] 0.12-0.86; P = 0.024）。包含KPS （OR 14.5; 95%CI 4.34-48.6; P < 0.001）和年龄（OR 1.04; 95%CI 1.01-1.08; P = 0.014）的多变量模型对术后并发症的预测准确率最高（校正AUC 0.72; 95%CI 0.63-0.80）。mRCC根治性肾切除术后的术后并发症很常见，经常发生在老年患者和KPS较差的患者中。这些并发症很重要，因为它们可能延迟或拒绝接受后续的全身治疗。
To evaluate and identify factors predictive for morbidity after radical nephrectomy in patients with metastatic renal cell carcinoma (mRCC). We identified patients with mRCC who underwent nephrectomy at Memorial Sloan-Kettering Cancer Center (MSKCC) between 1989 and 2009. Postoperative complications were characterised using a modified version of the Clavien-Dindo classification system. Patient and disease characteristics, including a previously validated MSKCC risk-stratification system using calcium, haemoglobin (Hb), lactate dehydrogenase, and Karnofsky Performance Status (KPS), were evaluated as predictors of postoperative complications using univariate and multivariable logistic regression models. The area under the receiver operating characteristic curve (AUC) was calculated for each model to assess predictive accuracy and corrected for overfit using 10-fold cross validation. Over the study period, 195 patients with mRCC underwent nephrectomy; 53 (27%) developed grade ≥2 complications within 8 weeks of surgery. Pulmonary, thromboembolic events and anaemia requiring transfusion were the most common types of complications after nephrectomy in the metastatic setting. In univariate analysis, age, low albumin, low KPS, high corrected serum calcium, low serum Hb, and unfavourable MSKCC risk score were predictive of complications. Patients who sustained postoperative complications were less likely to receive systemic therapy within 56 days (odds ratio [OR] 0.32; 95% confidence interval [CI] 0.12–0.86; P = 0.024). A multivariable model containing KPS (OR 14.5; 95%CI 4.34–48.6; P < 0.001) and age (OR 1.04; 95%CI 1.01–1.08; P = 0.014) showed the greatest predictive accuracy (corrected AUC 0.72; 95%CI 0.63–0.80) for postoperative complications. Postoperative complications after radical nephrectomy in the setting of mRCC are common and occur frequently in older patients and those with worse KPS. These complications are important because they may delay or deny receipt of subsequent systemic therapy.