Sunitinib might optimize the feasibility of partial nephrectomy (PN) for complex renal tumors with imperative indications. We compared the renal functional outcomes of patients with complex renal masses who had undergone sunitinib before PN with those of patients who had not required neoadjuvant sunitinib before PN.
We performed a multicenter retrospective analysis of patients with renal cell carcinoma who had undergone PN for a complex renal mass (R.E.N.A.L. nephrometry score, 10-12) and imperative indications from January 2012 to July 2014. Neoadjuvant sunitinib was used in cases for which PN was not considered feasible. The cohort was divided into those patients who had undergone PN without neoadjuvant sunitinib and those who had undergone PN after sunitinib (no-neoadjuvant vs. neoadjuvant). The change in tumor size and R.E.N.A.L. score were assessed. The primary outcome was the change in the estimated glomerular filtration rate (ΔeGFR) from preoperatively to the last postoperative follow-up visit.
The data from 125 consecutive patients were analyzed (47 neoadjuvant and 78 no-neoadjuvant; median follow-up, 21 months). The neoadjuvant plus PN patients had had a greater median tumor size preoperatively (7.2 vs. 6 cm; P = .045). Sunitinib caused a significant decrease in the median tumor size (from 7.2 to 5.8 cm [19.4%]; P = .012) and R.E.N.A.L. score (from 11 to 9; P = .001). No significant differences were found between the neoadjuvant and no-neoadjuvant groups in the ischemia time (P = .413) or incidence of complications (P = .728). The median ΔeGFR was similar (neoadjuvant, 6.4; no-neoadjuvant, 6.1; P = .534). Linear regression analysis for factors associated with an increasing ΔeGFR demonstrated increasing age (estimate, -0.074; P = .009) increasing body mass index (estimate, -0.087; P = .043), and decreasing baseline eGFR (estimate, -0.104; P = .02) as significant factors.
The use of neoadjuvant sunitinib might facilitate complex PN and result in renal functional outcomes similar to those of patients with a complex renal mass who had not required neoadjuvant sunitinib.
Clinical genitourinary cancer. 2017 Sep 25 [Epub ahead of print]
Michelle L McDonald, Brian R Lane, Juan Jimenez, Hak J Lee, Kendrick Yim, Ahmet Bindayi, Zachary A Hamilton, Charles A Field, Aaron S Bloch, Sumi Dey, Sabrina Noyes, Rana McKay, Frederick Millard, Brian I Rini, Steven C Campbell, Ithaar H Derweesh
Department of Urology, University of California, San Diego, School of Medicine, La Jolla, CA., Department of Urology, Spectrum Health, Grand Rapids, MI., Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH., Moores Cancer Center, University of California, San Diego, La Jolla, CA., Taussig Cancer Center, Cleveland Clinic, Cleveland, OH., Department of Urology, University of California, San Diego, School of Medicine, La Jolla, CA. Electronic address: .