Efficacy of retroperitoneal laparoscopic partial nephrectomy in the treatment of renal cell carcinoma and predictive value of Klotho,AAPR,and SIRI for prognosis
LU Tefei
ZHANG Lei
LI Xing
Abstract：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,A APR,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.
Keywords：renal cell carcinomaretroperitoneal laparoscopic partial nephrectomyKlothoalbumin/alkaline phosphatase ratiosystemic inflammatory response indexpredictive value
Publication Date：2025-04-30
Online Publishing Date：2026-08-26(First online date of this platform, not the publication date of the document)
Pages：7( 533-539 )