Predictors of Long-Term Survival after Renal Cancer Surgery - Beyond the Abstract

Renal cancer surgeries (radical nephrectomy or partial nephrectomy) are standard of care procedures for patients diagnosed with renal cell carcinoma. In order to preserve renal function, partial nephrectomy has been shown to be better in terms of functional outcomes without compromising oncologic outcomes. Long-term outcomes after partial and radical nephrectomy remain unanswered. 


In this article, Zabell and colleagues reported their retrospective study that evaluated the long-term impact of renal cancer surgery (RCS), both partial and radical nephrectomy, on renal functional outcomes and survival. Authors reviewed the records of 4,283 patients who underwent either partial (54%) or radical (46%) nephrectomy from 1997-2008. This study primarily focused on three outcome factors including preoperative glomerular filtration rate (GFR), new baseline GFR after surgery, and GFR loss related to surgery. 

To predict chronic kidney disease (CKD) status 5 years postoperatively, the study used cumulative probability ordinal modeling and multivariable logistic regression was used to predict nonrenal cancer mortality at 10 years. This study found that preoperative GFR and GFR loss related to surgery are the two most important predictors of the development of CKD. The most significant predictors of 10-year non-renal cancer mortality were found to be the preoperative GFR, the new baseline GFR, age, diabetes and heart disease. 

In conclusion, both preoperative GFR and perioperative GFR loss are the two most significant predictors of future development of CKD. Similarly, preoperative GFR and age are the most significant factors correlated with mortality. The results from this study may aid urologists and patients in their decision to pursue renal cancer surgery. Although the study is retrospective, it accumulates the experience of multiple tertiary centers who majorly focus on the management of kidney cancer with robust functional and follow up oncological data. 

References:
1. Campbell SC, Novick AC, Belldegrun A et al: Guideline for the management of the clinical T1 renal mass. J Urol 2009; 182: 1271.
2. Lane BR, Campbell SC, Demirjian S et al: Surgically induced chronic kidney disease may be associated with a lower risk of progression and mortality than medical chronic kidney disease. J Urol 2013; 189: 1649.

Written by: Zhamshid Okhunov, MD, University of California Irvine

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