Impact of tumour morphology on renal function decline after partial nephrectomy. (28th May 2013)

• Record Type: Journal Article
• Authors: Mehrazin, Reza; Palazzi, Kerrin L.; Kopp, Ryan P.; Colangelo, Caroline J.; Stroup, Sean P.; Masterson, James H.; Liss, Michael A.; Cohen, Seth A.; Jabaji, Ramzi; Park, Samuel K.; Patterson, Anthony L.; L'Esperance, James O.; Derweesh, Ithaar H.
• Is Part Of: BJU international. Volume 111:Number 8(2013:Apr.)
• Page Start: E374
• Page End: E382
• Publication Date: 2013-05-28
• Subjects: Genitourinary organs -- Diseases -- Periodicals; Genitourinary organs -- Surgery -- Periodicals; Urology -- Periodicals; 616.6
• DOI: 10.1111/bju.12149
• Languages: English
• ISSNs: 1464-4096

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bju12149-sec-0001" sec-type="section"> <title>Objective</title> <p> <list id="bju12149-list-0001" list-type="bullet"> <list-item> <p>To examine the association of renal morphology with renal function after partial nephrectomy (PN).</p> </list-item> </list> </p> </sec> <sec id="bju12149-sec-0002" sec-type="section"> <title>Patients and Methods</title> <p> <list id="bju12149-list-0002" list-type="bullet"> <list-item> <p>We conducted a multi‐institutional retrospective analysis of 322 PNs performed between 2003 and 2011.</p> </list-item> <list-item> <p>The RENAL nephrometry score for each lesion was determined and the estimated glomerular filtration rate (eGFR) was calculated preoperatively and at last follow‐up.</p> </list-item> <list-item> <p>We divided patients into two RENAL nephrometry score groups, low (<8) and high (≥8), and analysed and compared the outcomes of each group.</p> </list-item> <list-item> <p>The primary outcome was median change in eGFR between preoperative and last follow‐up (ΔeGFR). The secondary outcome was eGFR <60 mL/min/1.73m<sup>2</sup> at last follow‐up.</p> </list-item> <list-item> <p>Multivariable analysis was conducted to evaluate the risk factors for eGFR <60 mL/min/1.73 m<sup>2</sup> at last follow‐up.</p> </list-item> </list> </p> </sec> <sec id="bju12149-sec-0003" sec-type="section"> <title>Results</title> <p> <list id="bju12149-list-0003" list-type="bullet"> <list-item> <p>The median (interquartile range) follow‐up was 25.2 (13.5–39.3) months. Low (<italic>n</italic> = 165) and high (<italic>n</italic> = 157) RENAL score groups were well‐matched for baseline eGFR. The median tumour size (4.2 vs 2.4 cm, <italic>P</italic> < 0.001) was greater for the high group.</p> </list-item> <list-item> <p>In all, 64% of the low and 88.2% of the high RENAL score group (<italic>P</italic> < 0.001) had decreased eGFR at last follow‐up.</p> </list-item> <list-item> <p>Median eGFR was −7 for the low vs −13.8 mL/min/1.73 m<sup>2</sup> for the high group (<italic>P</italic> = 0.001); eGFR <60 mL/min/1.73 m<sup>2</sup> at last follow‐up was 27.3% for the low vs 37.6% for the high group (<italic>P</italic> = 0.057).</p> </list-item> <list-item> <p>Linear regression analysis showed that for each 1‐point increase in RENAL score, there was 2.5% decrease in eGFR (<italic>P</italic> = 0.002); for each 1‐cm increase in tumour size, there was 1.8% decrease in eGFR (<italic>P</italic> = 0.013). Area under curve analyses showed no significant difference between RENAL score and tumour size for prediction of <italic>de novo</italic> eGFR <60 mL/min/1.73 m<sup>2</sup> (<italic>P</italic> = 0.920) and ΔeGFR ≥50% (<italic>P</italic> = 0.85).</p> </list-item> <list-item> <p>Multivariable analysis showed that increasing RENAL score (odds ratio [OR] 1.24, <italic>P</italic> = 0.046) and decreasing preoperative eGFR (OR 1.10, <italic>P</italic> < 0.001) were risk factors for eGFR <60 mL/min/1.73 m<sup>2</sup> at last follow‐up.</p> </list-item> </list> </p> </sec> <sec id="bju12149-sec-0004" sec-type="section"> <title>Conclusions</title> <p> <list id="bju12149-list-0004" list-type="bullet"> <list-item> <p>Increasing RENAL nephrometry score is an independent risk factor for eGFR <60 mL/min/1.73 m<sup>2</sup> after PN.</p> </list-item> <list-item> <p>RENAL nephrometry score may serve as an additional measure for risk stratification before PN, but further investigation is required.</p> </list-item> </list> </p> </sec> </abstract>