Renal cancer surgery (RCS) can adversely impact long-term function and survival. We evaluate predictors of chronic kidney disease (CKD) at 5-years and non-renal cancer mortality (NRCM) 10-years after RCS.
We analyzed 4,283 patients undergoing RCS (1997-2008). Radical nephrectomy (RN) and partial nephrectomy (PN) were performed in 46%/54% of patients, respectively. Cumulative probability ordinal modeling was used to predict CKD status 5-years after surgery and multivariable logistic regression for predicting NRCM at 10-years. Relevant patient, tumor, and functional covariates were incorporated, including: A) preoperative glomerular filtration rate (GFR); B) new-baseline GFR after surgery; and C) GFR loss related to surgery=(A-B). In contrast, PN/RN was not utilized in the models due to concerns about strong selection biases associated with choice of procedure.
Multivariable modeling (Spearman rho=0.78) established preoperative GFR and GFR loss related to surgery as the most important predictors for development of CKD, while age/gender/race played secondary roles. Significant predictors of 10-year NRCM were preoperative GFR, new-baseline GFR, age, diabetes, and heart disease (all p<0.05). Multivariable modeling (c-index=0.71) established age and preoperative GFR as the most important predictors of 10-year NRCM, while GFR loss related to surgery only changed absolute mortality estimates by 1-3%.
GFR loss related to RCS, whether due to PN or RN, influences risk of developing CKD, but may have less impact on survival. In contrast, age and preoperative GFR, which reflects general health status, are more robust predictors of NRCM, at least for patients with good preoperative function or mild CKD.
The Journal of urology. 2017 Aug 28 [Epub ahead of print]
Joseph Zabell, Sevag Demirjian, Brian R Lane, Ithaar H Derweesh, Sudhir Isharwal, Chalairat Suk-Ouichai, Jitao Wu, Diego Aguilar Palacios, Steven C Campbell
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA., Department of Urology, Spectrum Health Medical Group, Michigan State University, Grand Rapids, MI, USA., Department of Urology, University of California - San Diego Health System, San Diego, CA, USA., Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Division of Urology, Department of Surgery, Siriraj Hospital, Mahidol University, Bangkok, Thailand., Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Urology, the Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China., Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA. Electronic address: .