693 ADULT COMORBIDITY EVALUATION-27 SCORE IS AN INDEPENDENT PREDICTOR OF POSTOPERATIVE RENAL DYSFUNCTION AND OVERALL SURVIVAL

Abstract

You have accessJournal of UrologyKidney Cancer: Evaluation and Staging1 Apr 2011693 ADULT COMORBIDITY EVALUATION-27 SCORE IS AN INDEPENDENT PREDICTOR OF POSTOPERATIVE RENAL DYSFUNCTION AND OVERALL SURVIVAL Conrad Maciejewski, Sarah Moore, Brendan Diederichs, Paul Cartledge, Gerald Todd, and Ronald Moore Conrad MaciejewskiConrad Maciejewski Edmonton, Canada More articles by this author , Sarah MooreSarah Moore Edmonton, Canada More articles by this author , Brendan DiederichsBrendan Diederichs Edmonton, Canada More articles by this author , Paul CartledgePaul Cartledge Edmonton, Canada More articles by this author , Gerald ToddGerald Todd Edmonton, Canada More articles by this author , and Ronald MooreRonald Moore Edmonton, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1660AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The Adult Comorbidity Evaluation 27 (ACE-27) is a validated comorbidity analysis questionnaire. The aim of our study was to evaluate the role of ACE-27 comorbidity score in predicting postoperative renal function outcomes as well as overall survival. METHODS The Alberta Urology Institute Nephrectomy Database is a comprehensive multicenter retrospective database encompassing all demographic, clinical, and pathologic outcomes of patients undergoing radical and partial nephrectomy for renal cell carcinoma in the last 5 years. A total of 690 patient charts have been abstracted. Preoperative demographic data was used to calculate ACE-27 comorbidity score. The Modification of Diet in Renal Disease equation was used to calculate GFR using preoperative and postoperative data within 3 months of surgery. Univariate and multivariate linear and logistic regression models were designed using age, tumor stage, GFR, surgical approach, ACE-27 score, and overall survival as covariates. RESULTS A total of 690 patients were evaluated, with a mean age of 59. Stage distribution showed 46% T1a, 17% T1b, 19% T2, 15% T3, and 2% T4. Mean preoperative GFR was 85 ± 30 ml/min. ACE-27 score distribution showed 34% scoring 0, 42% scoring 1, 16% scoring 2, and 7% scoring 3. Median follow up was 3.2 years. Univariate linear regression identified age, ACE-27 score, and surgical approach as predictors of postoperative GFR < 60 ml/min (p<0.0001). Multivariate linear regression analysis confirmed these results, with age, ACE-27 score, and surgical approach being independent predictors of postoperative GFR < 60 ml/min (p<0.0001). Survival data was available for 219 patients, with an overall 19.6% 5 year mortality. In multivariate logistic regression, age was the only statistically significant factor predicting mortality (p=0.009) with a trend for ACE-27 (p=0.08). Subgroup analysis of individual ACE-27 scores identified high comorbidity (ACE-27 = 3) to be an independent predictor of mortality (p=0.005). CONCLUSIONS Our data support the use of ACE-27 comorbidity score as a prognostic tool in clinical decision making for surgical management of renal cell carcinoma, in regards to postoperative renal function outcomes and overall survival. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e279 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Conrad Maciejewski Edmonton, Canada More articles by this author Sarah Moore Edmonton, Canada More articles by this author Brendan Diederichs Edmonton, Canada More articles by this author Paul Cartledge Edmonton, Canada More articles by this author Gerald Todd Edmonton, Canada More articles by this author Ronald Moore Edmonton, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...