Cancer - Kidney(구연) Oral Session 7 / Cancer - Kidney (Ⅰ) (O-073) Rm.201 10월 30일(수) 16:00-17:00 양측성 신장암 수술 후 신기능의 변화 양상에 대한 분석: 다기관, 성향점수매칭 분석 분당서울대학교병원 비뇨의학과교실 김정권, 정연수, 이학민, 오종진, 이상철, 정성진, 홍성규, 이상은, 변석수 Introduction: We evaluated renal functional outcomes after sequential partial nephrectomy and radical nephrectomy in patients with bilateral bilateral renal cell carcinoma (RCC). Materials and Methods: A total of 267 patients (synchronous bilateral RCCs, N=44 [88 lesions]; metachronous bilateral RCCs, N=45 [90 lesions]; unilateral RCCs, N=178 lesions) from two institutions (SNUH and SNUBH) were included in the study. Synchronous bilateral RCCs were defined as diagnosis concomitantly or within 3 months of the former tumor. Renal functional outcomes defined as estimated glomerular filtration rate (eGFR) changes and De novo chronic kidney disease (CKD, stage≥3) after surgery were assessed using propensity score matching analysis. Results: In subgroup of bilateral RCCs, patients underwent sequential partial nephrectomy (PN) (N=48), PN followed by radical nephrectomy (RN) (N=8) or RN followed by PN (N=25). Final eGFR after bilateral surgery was 79.4, 41.4, and 61.2 ml/minute/1.73 m2 in these 3 groups, respectively (P=0.003). There were significant differences between the groups in terms of eGFR decline from baseline and De novo CKD; PN followed by RN group showed the worst functional outcomes (all P<0.05, Table 1). In addition, sequential PN group in bilateral RCC group showed significantly higher rates of De novo CKD compared with synchronous RCC group (13.8% vs. 6.9%, P=0.016). However, there were no significant differences in comparison between the synchronous and metachronous bilateral RCC groups. On multivariate Cox regression analysis, hypertension (P=0.008) and sequence of surgery (PN followed by RN, P<0.001) were identified as significant predictors of De novo CKD. Conclusions: PN followed by RN showed the negative impact of renal functional preservation. Nephron sparing surgery should be conducted for all amenable bilateral RCCs. keywords : bilateral, functional outcomes, renal cell carcinoma