Washington, DC (UroToday.com) Cytoreductive nephrectomy has been shown to improve overall survival in patients with metastatic renal cell carcinoma (mRCC). At today’s 2017 SUO winter meeting poster session, Dr. Martin and colleagues presented their research identifying the rate and risks of chronic kidney disease development after cytoreductive nephrectomy. While radical nephrectomy in localized tumors has been estimated on meta-analysis to have a significant impact on risk of chronic kidney disease development , treatment outcomes in patients with more advanced disease have not been adequately assessed. Using patients enrolled in The Autologous Dendritic Cell Immunotherapy (AGS-003) Plus Standard Treatment of Advanced Renal Cell Carcinoma (ADAPT) trial that received cytoreductive nephrectomy in the metastatic setting, the objective of the current study was to assess the effect of cytoreductive nephrectomy on renal function in patients with mRCC.
The authors identified patients based on screening for the ADAPT trial undertaken from 2012−2015. Of the initial 1148 screened patients, 450 were enrolled in the trial. Preoperative creatinine was unavailable for five patients; furthermore, patients were also excluded with an abnormal estimated glomerular filtration rate (eGFR) (<60ml/min/1.73 m2) prior to nephrectomy. Univariate logistic regression analysis was used to evaluate the impact of patient and disease specific factors on post−operative renal function. Among the 371 patients included in the analysis, 15 underwent partial nephrectomy and 354 underwent radical nephrectomy (surgical approach was unknown for 2 patients). There were 169 patients (45.5%) who developed chronic kidney disease stage 3 or worse (<60ml/min/1.73 m2) with short−term follow up. Factors associated with post−operative glomerular filtration rate <60ml/min/1.73 m2 were: age (p=<0.001), hypertension (p=0.005), Charlson Comorbidity Index score (p=<0.001), prior history of nephrolithiasis (p=0.021), and presence of liver metastasis (p=0.004).
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The authors concluded that their findings indicate that nearly half of patients with mRCC develop new chronic kidney disease after cytoreductive nephrectomy. This risk appears more pronounced than treatment in lower stage tumors. Older patients and those with a history of hypertension and a higher comorbidity index appear to be at an increased risk of post−operative chronic kidney disease. This has important implications as renal replacement therapy could be a competing factor for morbidity and mortality in these patients. More follow−up is needed to better understand the long−term impact of these findings.
Speaker: Christopher Martin, Division of Urology, University of Utah, Salt Lake City, UT
Co-Authors: Eric Mayer, Robert Uzzo, Brian Lane, Alexander Kutikov, Marc Smaldone, Jason Gee, Larry Karsh, Thomas Gardner, Viraj Master, William Huang, Jeffrey Holzbeierlein, Neal Shore, William Lowrance
Written by: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre, @zklaassen_md, at the 18th Annual Meeting of the Society of Urologic Oncology, November 29-December 1, 2017 – Washington, DC
Kim SP, Thompson RH, Boorjian SA, et al. 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(1):51-57.