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• W1524347823 abstract "In the current issue of the International Journal of Urology, Yokoyama et al. developed and externally validated a prognostic model that prognosticates the risk of chronic kidney disease (CKD) after nephrectomy for renal cell carcinoma (RCC).1 Recognition of surgically-induced comorbidities is an important problem in the current surgical management of RCC patients. During the past years, the incidence of RCC has continuously risen. This is particularly true for localized RCC, whereas the incidence of metastatic RCC has slightly decreased.2 The increase in incidence of localized RCC is paralleled by an increase of partial or complete nephrectomies.3 However, despite earlier diagnosis and surgical treatment, overall age-adjusted mortality rates of RCC (number of RCC-specific mortality/population at risk adjusted to the 2000 USA standard population) have risen in all stages and, in particular, in localized stages from 1988 to 2006.2 Thus, we have to think about other risk factors of our RCC patients. A study of 30 801 patients with localized RCC (median follow up: 3.8 years; median patient age: 62 years) has shown that 4% and 7% had died from RCC after 5 and 10 years. However, at the same point of time, other types of cancer accounted for 7% and 11%, and comorbidities for 11% and 22% deaths in the same patient group.4 Furthermore, in another study the 3- and 5-year probabilities of new onset of chronic kidney disease (CKD; glomerular filtration rate [GFR] lower than 60 mL/min) were 20% and 33% after partial nephrectomy, and 65% and 77% after radical nephrectomy.5 At the same time, Go et al. have shown that after adjustment for other risk factors, a GFR of 45–60 mL/min is associated with a hazard ratio for death of 1.2 and 3.2 for a GFR of 15–29 mL/min.6 The results of new onset CKD and the increased risk of death according to Go et al. have led to a large debate in the urological community about our current clinical management of RCC patients. Interestingly, Lane et al. recently brought a completely new aspect in this debate with their differentiation between medically- and surgically-induced CKD.7 They showed in a large single center cohort that only preoperative, but not surgically-induced, CKD was associated with a higher risk for death after nephrectomy for RCC. This important aspect needs to be confirmed in further prospective randomized controlled trials, but it has already shown that the whole issue is more complex than we had thought. Another aspect is a potential overtreatment of RCC patients. Biopsy studies and systematic analyses of nephrectomies have shown that, in fact, 20–30% of tumor suspect renal lesions are benign tumors, and just 20–25% of all localized RCC harbor potentially aggressive tumor features.8-10 Collectively, modern clinical management of RCC patients needs to consider multiple factors, such as patients’ age, comorbidities and the potential likelihood of a benign lesion. Previous one-size-fits-all treatment concepts are a thing of the past. The prognostic model of Yokoyama et al. is one important step in this complex modern process. It will give physicians the possibility to estimate the postoperative likelihood of a new onset of CKD. In contrast, it specifically applies to Asian patients and, therefore, it could be a helpful tool for physicians in the growing Asian societies. None declared." @default.
• W1524347823 created "2016-06-24" @default.
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• W1524347823 date "2013-10-03" @default.
• W1524347823 modified "2023-09-23" @default.
• W1524347823 title "Editorial Comment to Renal function after radical nephrectomy: Development and validation of predictive models in Japanese patients" @default.
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• W1524347823 doi "https://doi.org/10.1111/iju.12279" @default.
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