To develop a clinically actionable predictive model to quantitate the risk of estimated glomerular filtration rate decline to ≤45 ml/min/1.73m2 following radical nephrectomy in order to better inform decisions between radical and partial nephrectomy.
Our prospectively maintained kidney cancer registry was reviewed for patients with pre-operative estimated glomerular filtration rate > 60 ml/min/1.73m2 who underwent radical nephrectomy for a localized renal mass. New baseline renal function was indexed. We used multivariable logistic regression to develop a predictive nomogram and evaluated it utilizing receiver operating characteristic analysis. Decision curve analysis assessed the net clinical benefit.
668 patients met inclusion criteria. 183 patients (27%) experienced estimated glomerular filtration rate decline to ≤ 45 ml/min/1.73m2 . On multivariable analysis, increasing age (p=0.001), female gender (p<0.001), and increasing pre-operative creatinine (p<0.001) were associated with functional decline. We constructed a predictive nomogram that included these variables in addition to comorbidities with a known association with kidney disease but found that a simplified model excluding comorbidities was equally robust (cross-validated area under receiver operating curve was 0.78). Decision curve analysis demonstrated the net-clinical benefit at probabilities >~11%.
The decision to perform radical vs. partial nephrectomy is multifaceted. We provide a simple quantitative tool to help identify patients at risk of a post-operative eGFR of ≤ 45 ml/min/1.73m2 who may be stronger candidates for nephron preservation. This article is protected by copyright. All rights reserved.
BJU international. 2019 May 30 [Epub ahead of print]
A G McIntosh, D C Parker, B L Egleston, R G Uzzo, H Haseebuddin, S S Joshi, R Viterbo, R E Greenberg, D Y T Chen, M C Smaldone
Fox Chase Cancer Center, Philadelphia , PA, USA., The University of Oklahoma Health Sciences, Center & The Stephenson Cancer Center, Oklahoma City, OK, USA., Frederick Urology Associates, Frederick, MD, USA.