We sought to determine whether loss of renal function increases risk of recurrence and metastases in renal cell carcinoma (RCC), and whether this impact was age-related.
We performed a retrospective analysis of the International Marker Consortium for Renal Cancer (INMARC) registry. Patients were separated into younger (<65 years old) and elder (≥65 years old) age groups, and rates of de novo estimated glomerular filtration rate (eGFR<45 mL/min/1.73m2 [eGFR<45]) were calculated. Multivariable analysis (MVA) was conducted for predictors of progression-free survival (PFS) and all-cause mortality (ACM). Kaplan-Meier Analysis (KMA) was conducted for PFS and overall survival (OS) in younger and elder age groups stratified by functional status.
We analyzed 1805 patients (1113 age<65, 692 age≥65). On MVA in patients <65, de novo eGFR<45 was independently associated with greater risk for worsened progression (HR=1.61, P=.038) and ACM (HR=1.82, P=.018). For patients ≥65, de novo eGFR<45 was not independently associated with progression (P=.736), or ACM (P=.286). Comparing patients with de novo eGFR<45 vs. eGFR ≥45, KMA demonstrated worsened 5-year PFS and OS in patients <65 (PFS: 68% vs. 86%, P<.001; OS: 73% vs. 90%, P<.001), while in patients ≥65, only 5-year OS was worsened (77% vs. 81%, P<.021).
Development of de novo eGFR<45 was associated with more profound impact on patients <65 compared to patients ≥65, being an independent risk factor for PFS and ACM. The mechanisms of this phenomenon are unclear but underscore desirability for nephron preservation when safe and feasible in younger patients.
Clinical genitourinary cancer. 2022 Dec 07 [Epub ahead of print]
Julia H Yuan, Hajime Tanaka, Dattatraya Patil, Kevin Hakimi, Shady Soliman, Margaret F Meagher, Ava Saidian, Arman Walia, Sohail Dhanji, Franklin Liu, Jonathan Afari, Mimi Nguyen, Luke Wang, Yosuke Yasuda, Kazutaka Saito, Yasuhisa Fujii, Viraj Master, Ithaar H Derweesh
Department of Urology, UC San Diego School of Medicine, La Jolla, CA., Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan., Department of Urology, Emory University School of Medicine, Atlanta, GA., Department of Urology, UC San Diego School of Medicine, La Jolla, CA. Electronic address: .