根治的膀胱摘出術後の糸球体濾過率の有意な低下の比較。傾向スコアマッチング分析

Comparison of a Significant Decline in the Glomerular Filtration Rate between Ileal Conduit and Ileal Neobladder Urinary Diversions after Radical Cystectomy: A Propensity Score-Matched Analysis.

• Jihion Yu
• Bumsik Hong
• Jun-Young Park
• Yongsoo Lee
• Jai-Hyun Hwang
• Yu-Gyeong Kong
• Young-Kug Kim

抄録

根治的膀胱摘出術後の尿路転用は腎機能障害のリスクと関連している。糸球体濾過率（GFR）の有意な低下（すなわち、12ヵ月後のベースラインGFRの30％以上の低下）は、長期的な腎機能障害と関連している。我々は、根治的膀胱摘出術後12ヵ月後に、回腸導尿路と回腸新膀胱尿路への導尿を行った場合の有意なGFR低下を比較した。根治的膀胱摘出術患者をレトロスペクティブに対象とした。傾向スコアをマッチさせた解析を行った。主要転帰は、根治的膀胱摘出術後12ヵ月後の回腸導管尿路転用（回腸導管群）と回腸新膀胱尿路転用（回腸新膀胱群）における有意なGFR低下の発生率とした。副次的転帰は両群のGFRの変化と末期腎疾患（ESRD）の発生率であった。プロペンシティスコアマッチング後の患者数は、回腸導管群と新膀胱群がそれぞれ117人であった。有意なGFR低下の発生率は、回腸導管群と回腸新膀胱群で有意差はなかった（12.0％ vs. 13.7％、＝0.845）。また、GFRの変化とESRD発症率には両群間で有意差はなかった（-8.4％ vs. -9.7％、＝0.480、4.3％ vs. 5.1％、＞0.999、それぞれ）。これらの結果は、根治的膀胱摘出術における尿路転用型の適切な選択に関する重要な情報を提供することができる。

Urinary diversion after radical cystectomy is associated with a risk of renal function impairment. A significant decline in the glomerular filtration rate (GFR) (i.e., a ≥30% decline in baseline GFR after 12 months) is associated with long-term renal function impairment. We compared the significant GFR decline between ileal conduit and ileal neobladder urinary diversions 12 months after radical cystectomy. We retrospectively included radical cystectomy patients. Propensity score-matched analysis was performed. The primary outcome was the incidence of a significant GFR decline in ileal conduit urinary diversion (ileal conduit group) and ileal neobladder urinary diversion (ileal neobladder group) 12 months after radical cystectomy. The secondary outcomes were the change of GFR and the incidence of end-stage renal disease (ESRD) in the two groups. After propensity score matching, the ileal conduit and neobladder groups had 117 patients each. The incidence of a significant GFR decline was not significantly different between ileal conduit and ileal neobladder groups (12.0% vs. 13.7%, = 0.845). The change of GFR and ESRD incidence were not significantly different between the two groups (-8.4% vs. -9.7%, = 0.480; 4.3% vs. 5.1%, > 0.999, respectively). These results can provide important information on appropriate selection of the urinary diversion type in radical cystectomy.