Abstract

Purpose: To compare acute kidney injury (AKI) incidence between nephron sparing surgery (NSS) and microwave ablation (MWA) for T1a RCC patients, reveal the effect of AKI on survival prognosis, construct AKI nomogram and use Law of Total Probability for survival probability (SP) prediction.

Materials and methods: Patients were studied retrospectively after NSS (n = 1267) or MWA (n = 210) from January 1, 2011 to June 30, 2017. Using one to one Propensity Score Matching (PSM), 158 pairs of patients were identified for the cohort study. AKI incidence, risk factors and impact on survival outcomes were analyzed using Chi-square test, logistic and cox regression analysis. AKI risk and SP were predicted by nomogram and Law of Total Probability. The performance of the nomogram was assessed with respect to its discrimination, calibration, and clinical usefulness.

Results: AKI occurred more commonly in NSS (27.85%) cohort, when compared to MWA (17.72%) cohort (p = 0.032), but treatment modality was not independently predictive of AKI occurrence (odds ratio [OR]: 0.598; 95% confidence interval [CI]: 0.282–1.265; p = 0.178). The 5-yr overall survival (OS) was lower in AKI patients (73.5%) compared with non-AKI patients (94.8%; p < 0.001). AKI was an independent risk factor for all-cause mortality in RCC patients (hazard ratio [HR]: 2.820; 95% confidence interval [CI]: 1.110–7.165; p = 0.029). Predictors for both NSS- and MWA-related AKI included tumor diameter, baseline eGFR and CCI score. RENAL score and tumor blood supply can predict AKI after NSS and MWA, respectively. The AKI normograms demonstrated good discrimination, with AUCs >0.86, excellent calibration and net benefits at the decision curve analysis with probabilities ≥5%. SP predicted by Law of Total Probability was comparable to actual OS.

Conclusion: AKI was an early indicator for poor overall survival in RCC patients. It can be predicted by several oncological parameters. Nomogram and Law of Total Probability can accurately predict AKI risk and SP.

摘要

目的：比较T1a RCC患者的肾保留手术（NSS）和微波消融（MWA）之间的急性肾损伤（AKI）发生率，揭示AKI对生存预后的影响，构建AKI诺模图，并使用总概率定律求生存概率（SP）预测。

材料和方法： 从2011年1月1日至2017年6月30日，在NSS（n  = 1267）或MWA（n = 210）之后对患者进行回顾性研究。使用一对一倾向得分匹配（PSM），确定了158对患者进行队列研究。使用卡方检验，logistic和cox回归分析分析了AKI发生率，危险因素以及对生存结果的影响。通过列线图和总概率定律预测AKI风险和SP。就其鉴别，校准和临床实用性评估了诺模图的性能。

结果：与MWA（17.72％）队列相比，NSS队列中AKI的发生率更高（27.85％）（p  = 0.032），但是治疗方式不能独立预测AKI的发生率（几率[OR]：0.598; 95％置信区间[CI]：0.282–1.265；p  = 0.178）。与非AKI患者（94.8％; p  <0.001）相比，AKI患者的5年总生存率（OS）较低（73.5％）。AKI是RCC患者全因死亡率的独立危险因素（危险比[HR]：2.820； 95％置信区间[CI]：1.110-7.165；p = 0.029）。与NSS和MWA相关的AKI的预测因素包括肿瘤直径，基线eGFR和CCI评分。RENAL评分和肿瘤血供可以分别预测NSS和MWA后的AKI。AKI规范图显示出良好的辨别力，AUC> 0.86，在决策曲线分析中概率≥5％时具有出色的校准和净收益。总概率定律预测的SP与实际OS相当。

结论： AKI是RCC患者总体生存不良的早期指标。可以通过几种肿瘤学参数进行预测。Nomogram和总概率定律可以准确预测AKI风险和SP。