To evaluate kidney functional and overall survival (OS) outcomes in a cohort of patients who underwent partial nephrectomy (PN) or radical nephrectomy (RN) for tumors ≤4 cm.
We performed a retrospective study on 2,110 patients who underwent PN or RN with normal contralateral kidneys and normal serum creatinine from 1989 through 2012.
Estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-epi) equation. Primary endpoints were baseline incidence of CKD, OS, and new onset of eGFR ≤60 and ≤45 mL/min/1. 73 m2.
Preoperatively, 30% and 8% of the cohort had eGFR ≤60 and ≤45 mL/min/1. 73 m2, respectively. Five-year freedom from eGFR ≤60 mL/min/1. 73 m2 was 24% (95% confidence interval [CI], 19%-30%) and 76% (95% CI, 72%-78%), and 5-year freedom from eGFR ≤45 mL/min/1. 73 m2 was 51% (95% CI, 45%-56%) and 91% (95% CI, 89%-93%), for RN and PN, respectively. On multivariable analysis, hazard ratio (HR) for RN vs PN was 4. 98 (95% CI, 4. 11-6. 04, P
This confirms prior work demonstrating that a significant proportion of patients have preexisting CKD. In patients with normal kidney function, RN is associated with a significantly higher risk for developing CKD and worse overall survival than PN.
Urology. 2015 Sep 08 [Epub ahead of print]
Joseph W Mashni, Melissa Assel, Alexandra Maschino, Mary Russo, Brendan Masi, Melanie Bernstein, William C Huang, Paul Russo
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY. , Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY. , Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY. , Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY. , Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY. , Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY. , Division of Urologic Oncology, Department of Urology, NYU Langone Medical Center, New York, NY. , Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.