MP47-16 DECLINE TO "SEVERE" CKD-S IS A PREDICTIVE MARKER FOR ALL-CAUSE AND NON-CANCER MORTALITY IN RENAL CELL CARCINOMA: ANALYSIS OF THE INTERNATIONAL MARKER CONSORTIUM FOR RENAL CANCER (INMARC)

Abstract

You have accessJournal of UrologyCME1 May 2022MP47-16 DECLINE TO "SEVERE" CKD-S IS A PREDICTIVE MARKER FOR ALL-CAUSE AND NON-CANCER MORTALITY IN RENAL CELL CARCINOMA: ANALYSIS OF THE INTERNATIONAL MARKER CONSORTIUM FOR RENAL CANCER (INMARC) Mimi Nguyen, Arman Walia, Rekha Narasimhan, Ava Saidian, John Matthew Perry, Hajime Tanaka, Kevin Hakimi, Margaret Meagher, Dattatraya Patil, Yosuke Yasuda, Kazutaka Saito, Yasuhisa Fujii, Viraj Master, and Ithaar Derweesh Mimi NguyenMimi Nguyen More articles by this author , Arman WaliaArman Walia More articles by this author , Rekha NarasimhanRekha Narasimhan More articles by this author , Ava SaidianAva Saidian More articles by this author , John Matthew PerryJohn Matthew Perry More articles by this author , Hajime TanakaHajime Tanaka More articles by this author , Kevin HakimiKevin Hakimi More articles by this author , Margaret MeagherMargaret Meagher More articles by this author , Dattatraya PatilDattatraya Patil More articles by this author , Yosuke YasudaYosuke Yasuda More articles by this author , Kazutaka SaitoKazutaka Saito More articles by this author , Yasuhisa FujiiYasuhisa Fujii More articles by this author , Viraj MasterViraj Master More articles by this author , and Ithaar DerweeshIthaar Derweesh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002618.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Impact of surgically induced Chronic Kidney Disease (CKD-S) on outcomes in renal cell carcinoma (RCC) is controversial. We evaluated effects of worsening CKD-S on oncologic and non-oncologic survival outcomes in RCC. METHODS: We performed a retrospective multicenter analysis of patients who underwent Partial (PN) or Radical Nephrectomy (RN). Primary outcome was all-cause mortality (ACM). Secondary outcomes were non-cancer mortality (NCM), cancer specific mortality (CSM), and de novo CKD-S Stage 4 [estimated glomerular filtration rate <30 mL/min/1.73m2). Patients were stratified by CKD stage: no CKD-S (eGFR≥60), de novo “moderate” CKD-S 3a (eGFR 59-45), de novo “moderate-severe” CKD-S 3b (eGFR 44-30) and de novo “severe” CKD-S 4 (eGFR 29-15). Multivariable analysis (MVA) was utilized to identify risk factors associated with development of CKD-S Stage 4 and mortality outcomes. Kaplan-Meier analysis (KMA) was utilized to evaluate for overall survival (OS), non-cancer survival (NCS), and cancer-specific survival (CSS) with respect to CKD-S categories. RESULTS: We analyzed 3239 patients [no CKD-S (n=1876), de novo CKD-S 3a (n=606), de novo CKD-S 3b (n=489) and de novo CKD-S 4 (n=268)]. On MVA, de novo CKD-S 4 was independently associated with ACM (HR 2.1, p <0.001) and NCM (OR 2.8, p <0.001), but not CSM (p=0.219); de novo CKD-S 3b was independently associated with ACM (HR 1.3, p=0.033) and NCM (OR 1.5, p=0.021), but not CSM (p=0.909); de novo CKD-S 3a was not predictive for any mortality outcomes (p=0.81-0.102). RN was independently associated with de novo CKD-S 4 (HR 1.4, p=0.047). Comparing no CKD, CKD-S 3a, CKD-S 3b and CKD-S 4, KMA demonstrated worsening outcomes with progressive CKD-S stage: 5 year OS 84% vs. 78% vs. 71% vs. 60%, p <0.001; 5 year NCS 93% vs. 87% vs. 83% vs. 72%, p <0.001; 5 year CSS, 91% vs. 92% vs. 86% vs. 83%, p <0.001 (Figure). CONCLUSIONS: Development of CKD-S Stage 3b and 4, but not Stage 3a, was associated with worsened ACM and NCM. Worsening CKD-S was not associated with increased oncological risk. While RN was predictive of “severe” CKD-S, decision to proceed with nephron preservation via PN should be individualized based on oncological risk and risk of functional decline to CKD-S 3b or 4, and not CKD-S 3. Source of Funding: Stephen Weissman Kidney Cancer Research Fund © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e816 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mimi Nguyen More articles by this author Arman Walia More articles by this author Rekha Narasimhan More articles by this author Ava Saidian More articles by this author John Matthew Perry More articles by this author Hajime Tanaka More articles by this author Kevin Hakimi More articles by this author Margaret Meagher More articles by this author Dattatraya Patil More articles by this author Yosuke Yasuda More articles by this author Kazutaka Saito More articles by this author Yasuhisa Fujii More articles by this author Viraj Master More articles by this author Ithaar Derweesh More articles by this author Expand All Advertisement PDF DownloadLoading ...