Retrospective studies suggest that partial nephrectomy (PN) provides improved survival compared to radical nephrectomy (RN), even when performed electively. However, selection-bias may be contributing. We evaluate factors associated with non-renal cancer-related mortality (NRCM) after PN/RN for patients with preoperative GFR≥60ml/min/1.73m.
3,133 patients with preoperative GFR≥60ml/min/1.73m managed with PN/RN were retrospectively evaluated. NRCM was analyzed by Kaplan-Meier based on procedure and functional parameters including new-baseline GFR. Cox-proportional-hazards assessed factors associated with NRCM among patients with new-baseline GFR≥45ml/min/1.73m.
Overall median age was 59 years and median preoperative-GFR was 85ml/min/1.73m in both the PN/RN cohorts. New-baseline GFR was 80ml/min/1.73m after PN and 63ml/min/1.73m after RN (p<0.001). Median follow-up was 9.3 years. Ten-year NRCM was 11.3% after PN and 17.7% after RN (p<0.001). NRCM was similar for all patients with new-baseline GFR≥45ml/min/1.73m(p=0.26) but increased 50% or greater for the cohort (n=290) with new-baseline GFR below this level(p=0.001). For patients with new-baseline GFR>45ml/min/1.73m, 10-year NRCM was still substantially improved after PN(10.6% versus 16.3%, p<0.001). In this patient population, age/gender and procedure(PN versus RN) were associated with NRCM(all p≤0.001) on multivariable analysis. In contrast, increased new-baseline GFR, as seen with PN, failed to associate with reduced NRCM.
For patients with GFR≥60ml/min/1.73m undergoing PN/RN, our data suggest that management should achieve new-baseline GFR≥45ml/min/1.73m if feasible, and PN should be prioritized if needed to accomplish this. For patients with new-baseline GFR≥45ml/min/1.73m, PN associated with improved survival even though its functional-dividend, increased new-baseline GFR, failed to correlate, suggesting that selection-bias may also be impacting outcomes.
The Journal of urology. 2019 Jan 25 [Epub ahead of print]
C Suk-Ouichai, H Tanaka, Y Wang, J Wu, Y Ye, S Demirjian, J Li, S C Campbell
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.