MP42-08 RENAL CANCER SURGERY FOR PATIENTS WITHOUT PREEXISTING CHRONIC KIDNEY DISEASE: IS THERE A SURVIVAL BENEFIT FOR ELECTIVE PARTIAL NEPHRECTOMY?

Abstract

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy IV1 Apr 2018MP42-08 RENAL CANCER SURGERY FOR PATIENTS WITHOUT PREEXISTING CHRONIC KIDNEY DISEASE: IS THERE A SURVIVAL BENEFIT FOR ELECTIVE PARTIAL NEPHRECTOMY? Chalairat Suk-Ouichai, Hajime Tanaka, Jitao Wu, Elvis R. Caraballo, Sevag Demirjian, Jianbo Li, Sudhir Isharwal, and Steven C. Campbell Chalairat Suk-OuichaiChalairat Suk-Ouichai More articles by this author , Hajime TanakaHajime Tanaka More articles by this author , Jitao WuJitao Wu More articles by this author , Elvis R. CaraballoElvis R. Caraballo More articles by this author , Sevag DemirjianSevag Demirjian More articles by this author , Jianbo LiJianbo Li More articles by this author , Sudhir IsharwalSudhir Isharwal More articles by this author , and Steven C. CampbellSteven C. Campbell More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1315AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Retrospective studies suggest that partial nephrectomy (PN) provides improved survival compared to radical nephrectomy (RN), even when performed electively. However, selection bias may be contributing and further investigation is required. We evaluated factors associated with non-renal cancer-related survival (NRCS) after PN or RN for patients with preoperative GFR ≥60ml/min/1.73m2. METHODS Our study represents a single-center, retrospective evaluation of 3,133 patients (1997-2008) with preoperative GFR ≥60ml/min/1.73m2 managed with PN or RN, with PN performed in 1,732 (55%) cases. NRCS was analyzed by Kaplan-Meier in various cohorts based on functional parameters including preoperative GFR and new baseline GFR but also by procedure (PN versus RN). Cox proportional hazards assessed factors associated with NRCS among patients with new baseline GFR ≥45ml/min/1.73m2. RESULTS Median age was 59 years and 60% of patients were male. Median preoperative GFR was 85 ml/min/1.73m2 in both the PN and RN cohorts. New baseline GFR after RCS was 80 ml/min/1.73m2 for PN and 63 ml/min/1.73m2 for RN (p<0.001). Median follow-up was 9.3 years. NRCS at 10-years was 90.7% after PN and 85.8% after RN (p<0.001). NRCS was similar for all cohorts of patients with new baseline GFR ≥45 ml/min/1.73m2 (p=0.26) and only fell for patients with new baseline GFR below this level (p=0.001). Excluding patients with new baseline GFR<45ml/min/1.73m2 (n=290), NRCS at 10-years was still substantially improved after PN than RN (91.2% vs. 87.1%, p<0.001). For patients with new baseline GFR ≥45ml/min/1.73m2, age, gender, and procedure (PN versus RN) were associated with NRCS (all p≤0.001) on multivariable analysis. In contrast, increased new baseline GFR, as would be seen with PN, failed to associate with improved NRCS. Limitation includes retrospective design. CONCLUSIONS For patients with GFR ≥60ml/min/1.73m2 undergoing RCS, our data suggest priority for achieving new baseline GFR ≥45ml/min/1.73m2. For this cohort, PN associated with improved survival even though increased new baseline GFR failed to correlate. Given that the functional dividends of elective PN did not correlate with better survival, our study suggests that selection bias for procedure is the main factor impacting outcomes. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e539 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Chalairat Suk-Ouichai More articles by this author Hajime Tanaka More articles by this author Jitao Wu More articles by this author Elvis R. Caraballo More articles by this author Sevag Demirjian More articles by this author Jianbo Li More articles by this author Sudhir Isharwal More articles by this author Steven C. Campbell More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...