Kidney function following partial or radical nephrectomy for renal cell carcinoma: A population-based study

Mariusdottir, Elin; Jónsson, Eiríkur; Marteinsson, Valur Thor; Sigurdsson, Martin I.; Guðbjartsson, Tómas

doi:10.3109/21681805.2013.783624

Cited by 22 publications

(24 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…18,19,21,22,24,27,28,31,32,36,60,[86][87][88] Authors of studies with statistically significant OS advantage for PN acknowledged differences in baseline characteristics (ie selection bias) that may have contributed to the observed findings. 23,25,26,74 In 10 SEER studies comprising the majority of patients in this analysis PN was associated with a statistically significant overall survival benefit compared to RN for clinical stage T1a tumors but not for T1b tumors. 61,64,65,67,68,70,[83][84][85] Therefore, meta-analyses were different for SEER (effect size 1.23, range 1.13 to 1.33) and nonSEER studies (1.09, 0.88 to 1.34, supplementary table 9, fig.…”

Section: Overall Survivalmentioning

confidence: 91%

Management of Renal Masses and Localized Renal Cancer: Systematic Review and Meta-Analysis

et al. 2016

View full text Add to dashboard Cite

Purpose-Several options exist for management of clinically localized renal masses suspicious for cancer, including active surveillance, thermal ablation and radical or partial nephrectomy. We summarize evidence on effectiveness and comparative effectiveness of these treatment approaches for patients with a renal mass suspicious for localized renal cell carcinoma. Materials and Methods-We searched MEDLINE®, Embase® and the Cochrane CentralRegister of Controlled Trials from January 1, 1997 through May 1, 2015. Paired investigators independently screened articles to identify controlled studies of management options or cohort studies of active surveillance, abstracted data sequentially and assessed risk of bias independently. Strength of evidence was graded by comparisons.Results-The search identified 107 studies (majority T1, no active surveillance or thermal ablation stratified outcomes of T2 tumors). Cancer specific survival was excellent among all management strategies (median 5-year survival 95%). Local recurrence-free survival was inferior for thermal ablation with 1 treatment but reached equivalence to other modalities after multiple treatments. Overall survival rates were similar among management strategies and varied with age and comorbidity. End-stage renal disease rates were low for all strategies (0.4% to 2.8%). Radical nephrectomy was associated with the largest decrease in estimated glomerular filtration rate and highest incidence of chronic kidney disease. Thermal ablation offered the most favorable perioperative outcomes. Partial nephrectomy showed the highest rates of urological complications but overall rates of minor/major complications were similar among interventions. Strength of evidence was moderate, low and insufficient for 11, 22 and 30 domains, respectively. * Correspondence: 600 N. Wolfe St., Park Building, Room 223, Baltimore, Maryland 21287 (telephone: 618-534-4942; FAX: 410-502-7711; hitenpatel@jhmi.edu). No direct or indirect commercial incentive associated with publishing this article.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.References 51 through 88 can be obtained at http://jurology.com/. HHS Public Access METHODS Data Sources and SearchesWe report results from a broader systematic review. Data Synthesis and AnalysisAll studies were summarized qualitatively. LRFS was defined as the absence of any persistent or recurrent disease in the treated region of the kidney or associated renal fossa after a single, curative intent initial treatment. This definition included persistent enhancement of any treated mass, a visually e...

show abstract

Section: Overall Survivalmentioning

confidence: 91%

Management of Renal Masses and Localized Renal Cancer: Systematic Review and Meta-Analysis

et al. 2016

View full text Add to dashboard Cite

show abstract

“…35 These patients were matched to participants who underwent radical nephrectomy according to time of operation, tumour node meta stasis stage, and tumour size. In comparison to partial nephrectomy, radical nephrectomy had a detrimental effect on eGFR 6 months after surgery (difference in eGFR of 12.6 ml/min/1.73 m 2 , P <0.001) and also increased the risk of new-onset CKD (defined as eGFR <60 ml/min/1.73 m 2 ; OR 3.07, 95% CI 1.03-9.79, P = 0.04).…”

Section: Nephrectomy and Ckdmentioning

confidence: 99%

“…In comparison to partial nephrectomy, radical nephrectomy had a detrimental effect on eGFR 6 months after surgery (difference in eGFR of 12.6 ml/min/1.73 m 2 , P <0.001) and also increased the risk of new-onset CKD (defined as eGFR <60 ml/min/1.73 m 2 ; OR 3.07, 95% CI 1.03-9.79, P = 0.04). 35 In a study of 6,433 patients who underwent partial or radical nephrectomy for T1a RCC in the USA between 1998 and 2005, 840 patients from each group were carefully matched on propensity scores to account for selection biases. 36 Those who underwent radical nephrectomy had a higher rate of new onset CKD than did those who underwent partial nephrectomy (20% versus 11%, HR 1.90, 95% CI 1.48-2.45), and the 5-year freedom from new-onset CKD was estimated to be 82% for radical nephrectomy versus 91% for partial nephrectomy (P <0.001).…”

Section: Nephrectomy and Ckdmentioning

confidence: 99%

Risk of chronic kidney disease after cancer nephrectomy

Li¹,

Lau²,

Rhee³

et al. 2014

Nat Rev Nephrol

View full text Add to dashboard Cite

The incidence of early stage renal cell carcinoma (RCC) is increasing and observational studies have shown equivalent oncological outcomes of partial versus radical nephrectomy for stage I tumours. Population studies suggest that compared with radical nephrectomy, partial nephrectomy is associated with decreased mortality and a lower rate of postoperative decline in kidney function. However, rates of chronic kidney disease (CKD) in patients who have undergone nephrectomy might be higher than in the general population. The risks of new-onset or accelerated CKD and worsened survival after nephrectomy might be linked, as kidney insufficiency is a risk factor for cardiovascular disease and mortality. Nephron-sparing approaches have, therefore, been proposed as the standard of care for patients with type 1a tumours and as a viable option for those with type 1b tumours. However, prospective data on the incidence of de novo and accelerated CKD after cancer nephrectomy is lacking, and the only randomized trial to date was closed prematurely. Intrinsic abnormalities in non-neoplastic kidney parenchyma and comorbid conditions (including diabetes mellitus and hypertension) might increase the risks of CKD and RCC. More research is needed to better understand the risk of CKD post-nephrectomy, to develop and validate predictive scores for risk-stratification, and to optimize patient management.

show abstract

“…Most prior studies have focused on differences in postoperative eGFR and risk of developing newonset CKD between patients undergoing PN and those undergoing RN, finding that patients who undergo RN have significantly lower postoperative eGFR and significantly higher risk of developing new-onset CKD after their operation (5)(6)(7). In recent studies conducted among patients who underwent a radical procedure, lower preoperative eGFR, older age, and history of comorbidities were associated with lower postoperative eGFR (8,9), whereas older age, history of comorbidities, and tobacco use have been independently associated with the development of CKD following nephrectomy (10)(11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

Factors Associated with Recovery of Renal Function following Radical Nephrectomy for Kidney Neoplasms

Zabor

Furberg

Mashni

et al. 2016

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

Background and objectives Partial nephrectomy or radical nephrectomy is the standard of care for patients with kidney neoplasms, but surgery may result in loss of renal function. We sought to identify patient characteristics associated with renal functional recovery following radical nephrectomy.Design, setting, participants, & measurements We performed a retrospective study among 572 patients with kidney neoplasms who underwent RN between 2006 and 2013. The primary endpoint was recovery of postoperative eGFR to the preoperative level. We plotted the trajectory of each patient's eGFR from their first postoperative visit up to 3 years after surgery. Cumulative incidence and competing risks regression estimated associations between patient and clinical characteristics and eGFR recovery, stratified by preoperative eGFR.Results Median age was 61.5 years; 68% of patients were male, and 89% were white. Overall, eGFR increased over time following an initial postoperative decrease. Median postoperative follow-up among survivors was 10.8 (minimum, 0.03; maximum, 36.0) months; during follow-up, 263 patients achieved eGFR recovery. Median time to eGFR recovery was 25.3 months. Two-year cumulative incidence of eGFR recovery was 49% overall and 44% and 58% among those with preoperative eGFR$60 and ,60 ml/min per 1.73 m 2 , respectively (P,0.001). On multivariable analysis, younger age at surgery and female sex were significantly associated with a higher chance of eGFR recovery among patients with preoperative eGFR,60 ml/min per 1.73 m 2 . Among patients with preoperative eGFR$60 ml/min per 1.73 m 2 , hypertension was significantly associated with a lower chance of eGFR recovery, whereas increased tumor size was significantly associated with a higher chance of eGFR recovery.Conclusions Overall, almost half of the patients in this study recovered to their preoperative eGFR by 2 years following surgery. Distributions of preoperative risk factors differed by preoperative eGFR, leading to distinct factors that were significantly associated with chance of eGFR recovery.

show abstract

Kidney function following partial or radical nephrectomy for renal cell carcinoma: A population-based study

Abstract: eGFR was significantly lower after RN, and these patients were three times more likely to develop new-onset CKD. These findings suggest that PN successfully preserves kidney function compared to RN, with good oncological outcome and survival.

Cited by 22 publications

References 36 publications

Management of Renal Masses and Localized Renal Cancer: Systematic Review and Meta-Analysis

Management of Renal Masses and Localized Renal Cancer: Systematic Review and Meta-Analysis

Risk of chronic kidney disease after cancer nephrectomy

Factors Associated with Recovery of Renal Function following Radical Nephrectomy for Kidney Neoplasms

Contact Info

Product

Resources

About