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• W2912139063 abstract "No AccessJournal of UrologyAdult Urology1 Jun 2019Renal Cancer Surgery in Patients without Preexisting Chronic Kidney Disease—Is There a Survival Benefit for Partial Nephrectomy?This article is commented on by the following:Editorial Comment Chalairat Suk-Ouichai, Hajime Tanaka, Yanbo Wang, Jitao Wu, Yunlin Ye, Sevag Demirjian, Jianbo Li, and Steven C. Campbell Chalairat Suk-OuichaiChalairat Suk-Ouichai Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand Equal study contribution. More articles by this author , Hajime TanakaHajime Tanaka Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio Departments of Urology, Tokyo Medical and Dental University, Tokyo, Japan Equal study contribution. More articles by this author , Yanbo WangYanbo Wang Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio First Hospital of Jilin University, Tokyo, Japan Equal study contribution. More articles by this author , Jitao WuJitao Wu Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio Changchun and Yantai Yuhuangding Hospital, Tokyo, Japan More articles by this author , Yunlin YeYunlin Ye Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio Yantai and Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China More articles by this author , Sevag DemirjianSevag Demirjian Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio More articles by this author , Jianbo LiJianbo Li Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio More articles by this author , and Steven C. CampbellSteven C. Campbell †Correspondence: Center for Urologic Oncology, Room Q10-120, 9500 Euclid Ave., Glickman Urologic and Kidney Institute Cleveland Clinic, Cleveland, Ohio 44195 telephone: 216-444-5595; FAX: 216-636-0770; E-mail Address: [email protected] Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000060AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Retrospective studies suggest that partial nephrectomy provides improved survival compared to radical nephrectomy even when performed electively. However, selection bias may contribute. We evaluated factors associated with nonrenal cancer related mortality after partial and radical nephrectomy in patients with a preoperative glomerular filtration rate of 60 ml/minute/1.73 m2 or greater. Materials and Methods: We retrospectively evaluated the records of 3,133 patients with a preoperative glomerular filtration rate of 60 ml/minute/1.73 m2 or greater who underwent partial or radical nephrectomy. Nonrenal cancer related mortality was analyzed by the Kaplan-Meier test based on procedure and functional parameters, including the new baseline glomerular filtration rate. We used the Cox proportional hazards model to assess factors associated with nonrenal cancer related mortality among patients with a new baseline rate of 45 ml/minute/1.73 m2 or greater. Results: Overall median age was 59 years and the median preoperative glomerular filtration rate was 85 ml/minute/1.73 m2. The new baseline glomerular filtration rate was 80 and 63 ml/minute/1.73 m2 and 10-year nonrenal cancer related mortality was 11.3% and 17.7% after partial and radical nephrectomy, respectively (each p <0.001). Median followup was 9.3 years. Nonrenal cancer related mortality was similar in all patients with a new baseline glomerular filtration rate of 45 ml/minute/1.73 m2 or greater (p = 0.26). However, it increased 50% or more in the 290 patients with a new baseline below this level (p = 0.001). In patients with a new baseline greater than 45 ml/minute/1.73 m2 10-year nonrenal cancer related mortality was still substantially improved after partial nephrectomy (10.6% vs 16.3%, p <0.001). In this population age, gender and partial vs radical nephrectomy were associated with nonrenal cancer related mortality on multivariable analysis (all p ≤0.001). In contrast, the increased new baseline glomerular filtration rate, as seen for partial nephrectomy, was not associated with reduced nonrenal cancer related mortality. Conclusions: In patients with a glomerular filtration rate of 60 ml/minute/1.73 m2 or greater who undergo partial or radical nephrectomy our data suggest that treatment should achieve a new baseline of 45 ml/minute/1.73 m2 or greater if feasible. Partial nephrectomy should be prioritized if needed to accomplish this. In patients with a new baseline rate of 45 ml/minute/1.73 m2 or greater partial nephrectomy was associated with improved survival. However, the functional dividend, namely the increased new baseline rate, failed to correlate, suggesting that selection bias may also impact outcomes. References 1. : Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004; 351: 1296. Google Scholar 2. and Coresh J: Chronic kidney disease. Lancet 2012; 379: 165. Google Scholar 3. : Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lancet Oncol 2006; 7: 735. Google Scholar 4. : Renal mass and localized renal cancer: AUA guideline. J Urol 2017; 198: 520. Link, Google Scholar 5. : Collaborative review of risk benefit trade-offs between partial and radical nephrectomy in the management of anatomically complex renal masses. Eur Urol 2016; 72: 64. Google Scholar 6. : Comparative effectiveness for survival and renal function of partial and radical nephrectomy for localized renal tumors: a systematic review and meta-analysis. J Urol 2012; 188: 51. Link, Google Scholar 7. : Nephron-sparing techniques independently decrease the risk of cardiovascular events relative to radical nephrectomy in patients with a T1a–T1b renal mass and normal preoperative renal function. Eur Urol 2015; 67: 683. Google Scholar 8. : Overall survival after partial versus radical nephrectomy for a small renal mass: systematic review of observational studies. Urol Pract 2014; 1: 27. 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Lancet 2010; 375: 2073. Google Scholar 26. : Relationship between renal parenchymal volume and single kidney glomerular filtration rate before and after unilateral nephrectomy. Urology 2011; 77: 1404. Google Scholar 27. : Compensatory hypertrophy after partial and radical nephrectomy in adults. J Urol 2014; 192: 1612. Link, Google Scholar 28. : Long-term renal function recovery following radical nephrectomy for kidney cancer: results from a multicenter confirmatory study. J Urol 2018; 199: 921. Link, Google Scholar 29. : Rationale for percutaneous biopsy and histologic characterization of renal tumours. Eur Urol 2012; 62: 491. Google Scholar 30. : Imprudent utilization of partial nephrectomy. Urology 2018; 117: 22. Google Scholar The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number. Supported by the Mochida Memorial Foundation for Medical and Pharmaceutical Research (HT), and the China Scholarship Council (YW). No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. Editor's Note: This article is the second of 5 published in this issue for which category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 1216 and 1217. © 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byHuang W, Donin N, Levey A and Campbell S (2019) Chronic Kidney Disease and Kidney Cancer Surgery: New PerspectivesJournal of Urology, VOL. 203, NO. 3, (475-485), Online publication date: 1-Mar-2020.Smith J (2019) This Month in Adult UrologyJournal of Urology, VOL. 201, NO. 6, (1025-1026), Online publication date: 1-Jun-2019.Related articlesJournal of Urology8 May 2019Editorial Comment Volume 201Issue 6June 2019Page: 1088-1096Supplementary Materials Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.Keywordskidney neoplasmsnephrectomykidney function testsmortalitychronicrenal insufficiencyMetricsAuthor Information Chalairat Suk-Ouichai Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand Equal study contribution. More articles by this author Hajime Tanaka Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio Departments of Urology, Tokyo Medical and Dental University, Tokyo, Japan Equal study contribution. More articles by this author Yanbo Wang Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio First Hospital of Jilin University, Tokyo, Japan Equal study contribution. More articles by this author Jitao Wu Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio Changchun and Yantai Yuhuangding Hospital, Tokyo, Japan More articles by this author Yunlin Ye Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio Yantai and Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China More articles by this author Sevag Demirjian Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio More articles by this author Jianbo Li Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio More articles by this author Steven C. Campbell Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio †Correspondence: Center for Urologic Oncology, Room Q10-120, 9500 Euclid Ave., Glickman Urologic and Kidney Institute Cleveland Clinic, Cleveland, Ohio 44195 telephone: 216-444-5595; FAX: 216-636-0770; E-mail Address: [email protected] More articles by this author Expand All The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number. Supported by the Mochida Memorial Foundation for Medical and Pharmaceutical Research (HT), and the China Scholarship Council (YW). No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. Editor's Note: This article is the second of 5 published in this issue for which category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 1216 and 1217. Advertisement PDF downloadLoading ..." @default.
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