BACKGROUND: To investigate the impact of tumour size on postoperative glomerular filtration rate (GFR) in patients undergoing radical nephrectomy (RN) for renal cell carcinoma (RCC).
METHODS: We retrospectively identified 1371 patients who underwent RN between 1995 and 2010. Serum creatinine levels were measured preoperatively, within 7days of RN, at 3months, 1 and 3years. We divided patients into three groups based on tumour size: A: ⩽ 4cm, B: 4-7cm, C: >7cm. The changes in GFR were compared and multivariate logistic regression was used to analyse the predictive value of tumour size for new-onset chronic kidney disease (CKD, GFR< 60mL/min/1.73m2).
RESULTS: The preoperative GFR was significantly different among the three groups (A: 83.0, B: 82.0, C: 79.4ml/min/1.73m2, P=0.040). The decrease in GFR from preoperative to within 7days was greater in group A than in groups B and C (28.2 versus 24.2 versus 18.5ml/min/1.73m2, P< 0.001). The GFR at 1year postoperative was lower in group A than in group C (58.4 versus 61.5ml/min/1.73m2, P=0.009), in contrast to preoperative GFR. The incidence of GFR decrease >30% was higher in Group A than in Groups B and C at 1year (52.4% versus 41.5% versus 33.7%, P< 0.001). On multivariate analysis Groups A and B had a 2.37-fold (95% confidence interval (CI) 1.56-3.60, P< 0.001) and 2.24-fold (95% CI 1.49-3.38, P< 0.001) higher risk of new-onset CKD compared with Group C.
CONCLUSIONS: Small tumour size is associated with CKD after RN. Partial nephrectomy should be considered in patients with tumour size 7cm or less.
Written by:
Jeon HG, Choo SH, Sung HH, Jeong BC, Seo SI, Jeon SS, Choi HY, Lee HM. Are you the author?
Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Reference: Eur J Cancer. 2013 Sep 20. pii: S0959-8049(13)00786-7.
doi: 10.1016/j.ejca.2013.08.018
PubMed Abstract
PMID: 24060356
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