ABSTRACT
Purpose: The study aimed to compare operative, functional, and oncological outcomes between partial nephrectomy (PN) and radical nephrectomy (RN) for entophytic renal tumors (ERTs) by propensity score matching (PSM) analysis. Methods: A total of 228 patients with ERTs who underwent PN or RN between August 2014 and December 2021 were assessed. A PSM in a 1:1 ratio was conducted to balance the differences between groups. Perioperative characteristics, renal functional, and oncological outcomes were compared between groups. Univariate and multivariate logistic and Cox proportional hazard regression analyses were used to determine the predictors of functional and survival outcomes. Results: After PSM, 136 cases were matched to the PN group (n = 68) and the RN group (n = 68). Patients who underwent RN had shorter OT, less EBL, and lower high-grade complications (all p <0.05) relative to those who underwent PN. However, better perseveration of renal function was observed in the PN group, which was reflected in 48-h postoperative AKI (44.1% vs. 70.6%, p = 0.002), 1-year postoperative 90% eGFR preservation (45.6% vs. 22.1%, p = 0.004), and new-onset CKD Stage ≥III at last follow-up (2.9% vs. 29.4%, p <0.001). RN was the independent factor of short-term (OR, 2.812; 95% CI, 1.369-5.778; p = 0.005) and long-term renal function decline (OR, 10.242; 95% CI, 2.175-48.240; p = 0.003). Furthermore, PN resulted in a better OS and similar PFS and CSS as compared to RN (p = 0.042, 0.15, and 0.21, respectively). RN (OR, 7.361; 95% CI, 1.143-47.423; p = 0.036) and pT3 stage (OR, 4.241; 95% CI, 1.079-16.664; p = 0.039) were independent predictors of overall mortality. Conclusion: Among patients with ERTs, although the PN group showed a higher incidence of high-grade complications than RN, when technically feasible and with experienced surgeons, PN is recommended for better preservation of renal function, longer OS, and similar oncological outcomes.
ABSTRACT
Propofol is one of the most common intravenous anesthetics which may cause neuronal cell death in young mice. HOX transcript antisense RNA (HOTAIR) was abnormally expressed in neurodegenerative diseases. However, the effect of HOTAIR on propofol-induced pyroptosis of neurons and related mechanisms are still unknown. In this study, propofol treatment significantly reduced neuronal the viability of neurons, and promoted the expression of inflammation-related factors. Propofol treatment also promoted neuron death and neuronal pyroptosis. All the above effects might be related to the propofol-induced overexpression of HOTAIR. Interestingly, knockdown of HOTAIR by shRNA (sh-HOTAIR) significantly inhibited neuronal pyroptosis, but increased neuronal viability. Further analysis showed that HOTAIR and Nod-like receptor protein1 (NLRP1) were the targets of miR-455-3p, respectively. Notably, propofol treatment decreased the level of miR-455-3p, while increased the level of NLRP1. In addition, sh-HOTAIR increased the level of miR-455-3p, which further inhibited the expression of NLRP1 and the activation of NLRP1 inflammasome, thereby inhibiting neuronal pyroptosis. More importantly, NLRP1 overexpression decreased neuronal viability, and reactivated NLRP1 inflammasome, thus reversing the inhibitory effect of sh-HOTAIR on pyroptosis. Our findings indicated that HOTAIR inhibited propofol-induced pyroptosis of neurons by regulating miR-455-3p/NLRP1 axis, indicating that HOTAIR may be a potential therapeutic target for propofol-induced neurotoxicity.