TY - JOUR
T1 - Analysis of Renal Functional Outcomes after Radical or Partial Nephrectomy for Renal Masses ≥7 cm Using the RENAL Score
AU - Kopp, Ryan P.
AU - Liss, Michael A
AU - Mehrazin, Reza
AU - Wang, Song
AU - Lee, Hak J.
AU - Jabaji, Ramzi
AU - Mirheydar, Hossein S.
AU - Gillis, Kyle
AU - Patel, Nishant
AU - Palazzi, Kerrin L.
AU - Wan, Jim Y.
AU - Patterson, Anthony L.
AU - Derweesh, Ithaar H.
PY - 2015/1/1
Y1 - 2015/1/1
N2 - Objective To determine if partial nephrectomy (PN) confers a renal functional benefit compared to radical nephrectomy (RN) for clinical T2 renal masses (T2RM) when adjusting for tumor complexity characterized by the RENAL nephrometry score. Methods A 2-center study of 202 patients with T2RM undergoing RN (122) or PN (80) (median follow-up, 41.5 months). RN and PN cohorts were subanalyzed according to RENAL sum as a categorical variable of <10 or ≥10. Primary outcome was median change in estimated glomerular filtration rate (ΔeGFR) between preoperative to 6 months postoperative. Logistic regression-identified prognostic factors and survival models analyzed association between the RENAL sum and the freedom from de novo chronic kidney disease (CKD; eGFR<60 mL/min/1.73m2). Results No significant differences existed between PN and RN for RENAL score. ΔeGFR was greater in RN (-19.7) vs PN (-11.9; P =.006). De novo CKD was 40.2% after RN vs 16.3% after PN (P <.001). RENAL score ≥10 (odds ratio, 6.67; P =.025) and RN among patients with RENAL score <10 (odds ratio, 24.8; P <.001) were independently associated with de novo CKD at 6 months by logistic regression. Among patients with RENAL score <10, median CKD-free survival was PN 38 vs RN 16 months (P =.001). Cox proportional hazard demonstrated decreasing risk of CKD for PN vs RN from RENAL 10 (hazard ratio, 0.836) to RENAL 6 (hazard ratio, 0.003; P =.001). Conclusion RN is independently associated with decreased renal function compared to PN for T2RM with RENAL sum ≤10, but not >10, with larger relative decrease in eGFR for each decrease in RENAL sum. Further investigation is required to determine optimal candidates for PN in T2RM.
AB - Objective To determine if partial nephrectomy (PN) confers a renal functional benefit compared to radical nephrectomy (RN) for clinical T2 renal masses (T2RM) when adjusting for tumor complexity characterized by the RENAL nephrometry score. Methods A 2-center study of 202 patients with T2RM undergoing RN (122) or PN (80) (median follow-up, 41.5 months). RN and PN cohorts were subanalyzed according to RENAL sum as a categorical variable of <10 or ≥10. Primary outcome was median change in estimated glomerular filtration rate (ΔeGFR) between preoperative to 6 months postoperative. Logistic regression-identified prognostic factors and survival models analyzed association between the RENAL sum and the freedom from de novo chronic kidney disease (CKD; eGFR<60 mL/min/1.73m2). Results No significant differences existed between PN and RN for RENAL score. ΔeGFR was greater in RN (-19.7) vs PN (-11.9; P =.006). De novo CKD was 40.2% after RN vs 16.3% after PN (P <.001). RENAL score ≥10 (odds ratio, 6.67; P =.025) and RN among patients with RENAL score <10 (odds ratio, 24.8; P <.001) were independently associated with de novo CKD at 6 months by logistic regression. Among patients with RENAL score <10, median CKD-free survival was PN 38 vs RN 16 months (P =.001). Cox proportional hazard demonstrated decreasing risk of CKD for PN vs RN from RENAL 10 (hazard ratio, 0.836) to RENAL 6 (hazard ratio, 0.003; P =.001). Conclusion RN is independently associated with decreased renal function compared to PN for T2RM with RENAL sum ≤10, but not >10, with larger relative decrease in eGFR for each decrease in RENAL sum. Further investigation is required to determine optimal candidates for PN in T2RM.
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U2 - 10.1016/j.urology.2015.02.067
DO - 10.1016/j.urology.2015.02.067
M3 - Article
C2 - 26189330
AN - SCOPUS:84939775249
VL - 86
SP - 312
EP - 319
JO - Urology
JF - Urology
SN - 0090-4295
IS - 2
ER -