Surgery For Renal Cell Carcinoma Research Articles

The Fuhrman grading system has no prognostic value in patients with nonsarcomatoid chromophobe renal cell carcinoma.

The prognostic value of the Fuhrman nuclear grading system has been questioned for chromophobe renal cell carcinoma (chRCC) because this subtype frequently displays nuclear and nucleolar pleomorphism. The present study reevaluates this grading system in a series of patients with nonsarcomatoid chRCC. We identified 176 patients (3.6%) with nonsarcomatoid chRCC in a total of 4897 patients who underwent surgery for renal cell carcinoma at 5 centers in Germany between 1990 and 2010. The mean follow-up was 51.1 months. The 3 groups (G1 versus G2 versus G3/4) were comparable in terms of age, sex, tumor diameter, and lymph node metastasis. They only differed significantly in tumor stage (P = .01) and the incidence of synchronous visceral metastasis (P = .04). The 5-year cancer-specific survival rates were 84.4% for G1 (n = 32), 84.3% for G2 (n = 108), and 74.1% for G3/4 tumors (n = 33) (P = .58). Accordingly, multivariate analysis including age, sex, tumor stage, and metastatic disease did not identify Fuhrman grading as an independent predictor of cancer-specific survival in patients with chRCC (P = .4). We were able to demonstrate in a large multicenter cohort that the Fuhrman grading system does not qualify as a prognostic tool in patients with chRCC.

Renal insufficiency is associated with an increased risk of papillary renal cell carcinoma histology.

End-stage renal disease (ESRD) and acquired renal cystic disease associated with dialysis are known risk factors of papillary renal cell carcinoma (pRCC); however, it is not known whether renal insufficiency alone is a risk factor for pRCC. Our aim was to test whether renal insufficiency is associated with an increased preponderance of pRCC. Retrospective review of institutional database to identify all patients who underwent extirpative renal surgery for renal cell carcinoma (RCC) with complete records from 1992 to 2012. We excluded those patients with preoperative ESRD as defined by GFR < 15 mL/min/1.73 m(2). The dependent variable was histologic RCC subtype. Independent variables included demographic data, comorbidities, and renal functional data. Multivariate analysis by binary logistic regression was used to determine factors that independently were associated with pRCC development. A total of 1,226 patients met inclusion criteria, of which 15 % were pRCC. There was a positive association between likelihood of pRCC histology of RCC and increasing preoperative chronic kidney disease (CKD) stage (p = 0.021). Multivariate regression analysis indicated that male gender, race, and declining renal function categorized both by GFR and CKD stage were independently associated with a higher likelihood of pRCC histology as compared to other RCC histology. Within a large cohort of patients with a diagnosis of RCC, declining renal function was independently associated with an increased likelihood of pRCC histology. This finding and the available molecular evidence indicating protein expression similarity between pRCC and resident stem cells, which appear to be upregulated with kidney damage, suggest a possible causal relationship between renal injury and pRCC.

Surgical management of renal cell carcinoma with inferior vena cava thrombus

AimThe aim of the present study was to evaluate the short‐term outcome of renal cell carcinoma with inferior vena cava (IVC) thrombus treated by radical nephrectomy and IVC thrombectomy.Patients and MethodsTen consecutive patients who underwent surgery for renal cell carcinoma with IVC thrombus between August 2008 and November 2011 were studied retrospectively in terms of clinical presentation, intraoperative details, surgical approaches, pathology and outcomes.ResultsTen patients were treated surgically for renal cell carcinoma. They all had renal vein and IVC involvement (Neves–Zincke classification: level I: n = 1, level II: n = 3, level III: n = 3, level IV: n = 3). The majority presented with gross haematuria (80 per cent) and various degrees of anaemia (70 per cent). Mean operation time was 404 min. Intraoperative blood loss ranged from 400 mL to 13500 mL. One postoperative death was recorded, and intraoperative and postoperative morbidities (tumour thrombus pulmonary embolism, IVC thrombosis, retroperitoneal fluid collection) complicated recovery in four patients. Evidence of disease progression was observed in seven patients (70 per cent) upon follow up.ConclusionRenal cell carcinoma with IVC extension is a challenging disease entity. Despite the technical demand and high morbidity, radical nephrectomy plus IVC thrombectomy can be performed with reasonable outcomes in a local centre with multidisciplinary support.

Solidifying prognosis after surgery for renal cell carcinoma.

Dason and colleagues from Dublin, Ireland have added an interesting series to the canon of nephrectomy outcomes, and have further validated and solidified the prognostic implications of stage, grade and histology in renal cell carcinoma (RCC). 1 Newer series such as this one have renewed value in that they may provide a window into RCC outcomes in an era when the peculiarities of the small renal mass (SRM) have gained prominence. 2 The increasing incidence of RCC, attributed in large part to increased abdominal imaging, has typically accompanied a downward stage migration, with smaller incident masses and the expectation of lower stage and grade. Surgical series of SRM pathology have confirmed that a decreasing size of tumour is associated with increased benign diagnosis, and lower markers of aggressiveness. 3 These expectations are not met here, as the increasing surgical volume is accompanied by unchanged tumour size and stage, while grade decreased as might be expected. This finding stirs the mind into seeking a biological rationale to explain it, and indeed the authors concede that reasons are not particularly obvious. The tertiary care environment may play a role here, as referral patterns might distill more challenging cases toward these centres, while smaller or more favourable masses are handled outside. The preponderance of SRMs has also paralleled the introduction of thermal ablation techniques, active surveillance and watchful waiting due to competing risks, so smaller or more indolent-behaving masses may be

656 Role of nephrometric scores (P.A.D.U.A and R.E.N.A.L score) in the prediction of warm ischemia time and postoperative complications in patients who underwent elective open or minimally invasive nephron sparing surgery for renal cell carcinoma

656 Role of nephrometric scores (P.A.D.U.A and R.E.N.A.L score) in the prediction of warm ischemia time and postoperative complications in patients who underwent elective open or minimally invasive nephron sparing surgery for renal cell carcinoma

Safety and efficacy of preoperative sorafenib therapy in facilitating cytoreductive surgery in renal cell carcinoma.

With 65,000 new cases in the USA in 2013, the incidence of kidney cancer has doubled in last decade and accounted for 13,600 deaths in 2013 [1,2]. Renal cell carcinoma (RCC), which consists of 80% of kidney cancers in adults [3], presents with advanced or metastatic stage in approximately a third of patients. A third of earlystage RCC will subsequently recur or progress to metastatic disease after initial nephrectomy [4]. Historically, once surgical options were exhausted, metastatic RCC was regarded as refractory to any systemic therapy. The identification of the role of VEGF and mTOR in the development and progression of RCC has led to the discovery of several targeted therapies. Many of these agents, including tyrosine kinase inhibitors (sorafenib, sunitinib, pazopanib and axitinib), VEGF inhibitor (bevacizumab used in combination with IFN-α) and mTOR inhibitors (temsirolimus and everolimus) have now received US FDA approval. Despite all these advancements, metastatic RCC still remains an incurable disease with a median overall survival rate in the range of approximately 2 years [4]. In this article, we discuss the role of cytoreductive surgery in the era of targeted agents, and the role of preoperative use of sorafenib.

MP45-14 COMPARISON OF RESPONSE RATES TO QUALITY OF LIFE SURVEYS BETWEEN PATIENTS UNDERGOING SURGERY FOR RENAL CELL CARCINOMA AND PROSTATE CANCER

You have accessJournal of UrologyProstate Cancer: Localized III1 Apr 2014MP45-14 COMPARISON OF RESPONSE RATES TO QUALITY OF LIFE SURVEYS BETWEEN PATIENTS UNDERGOING SURGERY FOR RENAL CELL CARCINOMA AND PROSTATE CANCER Andrew Davidiuk, Alexander Parker, Gregory Broderick, Kaitlynn Custer, Andrea Tavlarides, Michelle Arnold, and David Thiel Andrew DavidiukAndrew Davidiuk More articles by this author , Alexander ParkerAlexander Parker More articles by this author , Gregory BroderickGregory Broderick More articles by this author , Kaitlynn CusterKaitlynn Custer More articles by this author , Andrea TavlaridesAndrea Tavlarides More articles by this author , Michelle ArnoldMichelle Arnold More articles by this author , and David ThielDavid Thiel More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1211AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives Improvements in survival times following surgery for clinically localized prostate cancer (PCa) and renal cell carcinoma (RCC) have led to an increased interest in evaluating factors associated with post-treatment quality of life (QOL) among these patients. Related to this, we examined overall response rates to QOL surveys, as well as factors associated with response, in these two patient populations. Methods Patients who underwent surgery for RCC or PCa at our institution between 2006 and 2012 were offered enrollment in a prospective registry that included baseline and annual QoL assessment. We identified 201 patients in the RCC registry and 616 patients in the PCa registry who completed a baseline QoL survey and were mailed a follow-up QoL at one and two years post surgery [RCC: SF-36, FACT–G (73 questions), PCa: EPIC, IIEF, Max-PC (80 questions)]. We compared patient characteristics between responders (i.e. those that returned at least a one or two-year follow-up) and non-responders using a Wilcoxon rank-sum test for continuous variables and a Fisher’s Exact test for categorical variables. To compare cancer-specific survival (CSS) between responders and non-responders we employed Cox Proportional Hazards models. All statistical tests were two-sided, with significance set at p= 0.05. Results The overall response rate for the PCa and RCC groups were 63% and 48% (p<0.001), respectively. Interestingly, this difference in response rate remained when we limited analysis to only those with early stage disease (pT2a for PCa and pT1 RCC, 62% vs. 52%; p=0.03). Among the PCa group, characteristics associated with response included older age (64.1 vs 62.6 years, p=0.032) and robotic versus open surgery (56% vs 44%; p=0.009). We observed no significant difference in CSS between PCa responders and non-responders. By comparison, we identified no characteristics that were associated with response in RCC group; however, non-responders had poorer CSS compared to responders. Conclusions Surgically treated PCa patients have significantly higher QOL survey response rates than those patients with RCC. Societal awareness and education regarding RCC remains behind that of PCa, possibly due to the increased incidence of PCa, as well as an increase in men’s health awareness programs. The results may also indicate that patient’s expectations regarding surgery for RCC rely more heavily on survival, as opposed to PCa, where long-term quality of life continues to be a focus following surgery. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e464-e465 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Andrew Davidiuk More articles by this author Alexander Parker More articles by this author Gregory Broderick More articles by this author Kaitlynn Custer More articles by this author Andrea Tavlarides More articles by this author Michelle Arnold More articles by this author David Thiel More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Warm ischemia time and postoperative complications after partial nephrectomy for renal cell carcinoma

ObjectiveTo evaluate the correlations between PADUA and RENAL scores, WIT and postoperative complications in a cohort of patients who underwent elective open or minimally invasive nephron sparing surgery for renal cell carcinoma. Materials and methodsWe analyzed 96 consecutive patients who underwent partial nephrectomy for renal cell carcinoma between 2004 and 2013 at our Institution. The Spearman test was used to compare categorical variables. For all statistical analyses, a two-sided p<.05 was considered statistically significant. ResultsThe median (IQR) PADUA score was 7 (7–8) and the median (IQR) RENAL score was 7 (6–8). The median (IQR) warm ischemia time was 14min (8–20). Low grade and high grade postoperative complications were found in 27 (28.1%) and 6 (6.3%) patients, respectively. PADUA risk group categories significantly correlated with WIT>20min and high grade postoperative complications, respectively (p=.04), regardless of the surgical approach. RENAL risk group categories significantly predicted longer hilar clamping time in our cohort (p=.04), but no statistically significant correlations with high grade postoperative complications were found. ConclusionsIn our retrospective series nephrometric scores demonstrated to significantly predict longer warm ischemia time and higher postoperative complications, especially in those patients with more challenging and complex renal tumors. Therefore, when planning to perform partial nephrectomy, urologists should widely use these comprehensive tools.

Port Site Metastasis after Surgery for Renal Cell Carcinoma: Harbinger of Future Metastasis

Port site metastasis is a rare occurrence after minimally invasive treatment for renal cell carcinoma. However, its prognostic implications are unclear because reports in the literature are heterogeneous in detail and followup. We clarify the significance of port site metastasis in cancer specific survival and broaden our understanding of this phenomenon. A MEDLINE® search for published studies of renal cell carcinoma port site metastasis was performed. Contributing factors to port site metastasis, stage, Fuhrman grade, pathology, port site metastasis treatment method, followup protocol and long-term outcomes were collected. The corresponding authors of each publication were contacted to fill in details and provide long-term outcomes. We added 1 case from our recent experience. A total of 16 cases from 12 authors (including ourselves) were found. Of the 12 authors 8 were available for correspondence and 9 cases were updated. Eventual outcomes were available for 11 of the 16 cases and survival curves showed poor prognosis with a 31.8% overall 1-year survival rate. Of the 16 cases 12 were radical nephrectomy and 4 were partial nephrectomy, and 13 involved multiple metastases in addition to the port site metastasis. Nine of the cases hadno identifiable technical reason for port site metastasis formation such as specimen morcellation, absence of entrapment or tumor rupture. These tumors were uniformly aggressive, Fuhrman grade 3 or higher. Port site metastasis after minimally invasive surgery for renal cellcarcinoma is a rare occurrence with a poor prognosis. In most cases port sitemetastasis is not an isolated metastasis but instead is a harbinger of progressive disease. While technical factors can have a role in port site metastasis formation, it appears that biological factors like high tumor grade also contribute.

Tiempo de isquemia caliente y complicaciones postoperatorias después de la nefrectomía parcial por carcinoma de células renales

ObjectiveTo evaluate the correlations between PADUA and RENAL scores, WIT and postoperative complications in a cohort of patients who underwent elective open or minimally invasive nephron sparing surgery for renal cell carcinoma. Material and methodsWe analyzed 96 consecutive patients who underwent partial nephrectomy for renal cell carcinoma between 2004 and 2013 at our Institution. The Spearman test was used to compare categorical variables. For all statistical analyses, a two-sided P<.05 was considered statistically significant. ResultsThe median (IQR) PADUA score was 7 (7-8) and the median (IQR) RENAL score was 7 (6-8). The median (IQR) warm ischemia time was 14min (8-20). Low grade and high grade postoperative complications were found in 27 (28.1%) and 6 (6.3%) patients, respectively. PADUA risk group categories significantly correlated with WIT>20minutes and high grade postoperative complications, respectively (P=.04), regardless of the surgical approach. RENAL risk group categories significantly predicted longer hilar clamping time in our cohort (P=.04), but no statistically significant correlations with high grade postoperative complications were found. ConclusionsIn our retrospective series nephrometric scores demonstrated to significantly predict longer warm ischemia time and higher postoperative complications, especially in those patients with more challenging and complex renal tumors. Therefore, when planning to perform partial nephrectomy, urologists should widely use these comprehensive tools.

The dilemma of distance: patients with kidney cancer from regional Australia present at a more advanced stage

To determine whether patients from regional areas undergoing surgery for kidney cancer present with more advanced disease as a result of geographic isolation. Retrospective analysis of 221 patients undergoing surgery for renal cell carcinoma (RCC) from January 2004 to June 2012, from both a metropolitan centre and a large inner regional hospital. Data was collected on age, gender, presentation (incidental or symptomatic), clinical stage and pathological features. The Australian Standard Geographical Classification-Remoteness Area (ASGC-RA) is a system developed to allow quantitative comparisons between metropolitan and rural Australia. A score was assigned to each patient based on their location of residence at the time of surgery: metropolitan, RA1; inner regional, RA2; outer regional, RA3. Statistical significance was specified as P < 0.05 on Pearson's chi-square tests. Patients in each ASGC-RA group did not differ significantly in age, sex or mode of presentation. Pathological T stage on presentation increased with increasing ASGC-RA and thus distance from tertiary centres (P = 0.004). The proportion of patients with ≥T3 disease rose from 30% of RA1 to 73% of RA3 patients (P = 0.016) treated at our tertiary centre. Similarly, our regional centre had a larger proportion of patients presenting with ≥T3 disease from RA3 (31% vs 5%, P = 0.003). When the 221 patients with RCC were analysed as a group, clinical T stage was significantly associated with ASGC-RA (P < 0.001), symptomatic presentation (P < 0.001), N stage (P < 0.001), M stage (P < 0.001) and Fuhrman grade (P < 0.001). Our data quantifies the detrimental effect of physical distance on the health outcomes of regional Australians with kidney cancer. Australia's unique geography and rural culture may preclude any attempts to centralise cancer care to specialised metropolitan units, as has occurred in other countries.

Böbrek Hücreli Karsinomda Cerrahi Tedavi, Kardiyopulmoner Baypasın Hayati Rolü

Böbrek Hücreli Karsinomda Cerrahi Tedavi, Kardiyopulmoner Baypasın Hayati Rolü

Cost-effectiveness Analysis of Laparoscopic Surgery Versus Open Surgery in Renal Cell Carcinoma at Inner Mongolia Medical University Subsidiary Hospital in Inner Mongolia, China

The purposes of this study are to calculate the treatment cost on the perspective of provider, to assess short outcome (complications avoided) as well as the cost - effectiveness of the surgical treatments for renal cell carcinoma. This study aims to compare the 30 patients of laparoscopic surgery with 30 patients of open surgery in Inner Mongolia Medical University Subsidiary Hospital in Inner Mongolia in China during 2010-201. The data source is from the medical records and hospital cost accounting bills. The results showed that the cost of laparoscopic surgery is $ 1326.2/person, the number of complications avoided patients are 24 out of 30 patients. Therefore, the average cost of each complications avoided is $55.25. Moreover, the cost of open surgery is 920.6/person, the number of complications avoided patients are 26 out of 30 patients and the average cost of each complications avoided is $35.4. In conclusion, from the provider perspective's point of view and based on the limited available database, the effectiveness of open surgery seems to be better than the effectiveness of laparoscopic surgery. However, the interpretation of the study results should be with caution regarding the implementation of a surgical procedure to treat this disease further since this study employed only one hospital data base and a short period of time. Over which the other members in the society dare not to doubt nor dispute.

Is perioperative examination of frozen sections necessary in nephron-sparing surgery?

To evaluate the role of perioperative freezing in the management of surgical procedures in patients with malignant renal masses. The study group consisted of 17 patients diagnosed with renal masses who underwent nephron-sparing surgery. The group included 5 females and 12 males aged from 44 to 68 years (mean = 54.6). The mean mass size was 5.5 cm. Mass locations were as follows: 9 were in the lower pole, 4 were in the mid-pole, and 6 were in the upper pole. Perioperative freezing was not carried out. The patients were followed-up in a period ranging from 3 months to 7 years. Tumor pathology was reported as renal cell carcinoma in all cases, and surgical margins were negative in all of them. One patient died after 1 year because of tumor metastasis. In another patient, the tumor reoccurred in the same kidney and a radical nephrectomy was performed. Other patients were followed without recurrence. Imaging of the renal vascular system and freezing during surgery is not necessary for nephron-sparing surgery for renal cell carcinoma; however, we should be careful in terms of capsule invasion because of tumor recurrence.

Renal Cell Carcinoma with venous neoplastic thrombosis: A ten years review

To review the 10-year experience of our urological unit in the surgical management of renal cell carcinoma (RCC) with neoplastic tumor thrombosis focusing on postoperative survival. We underwent a retrospective analysis of the patients treated for this pathology during the last decade 2002-2012, stratifying them by tumor thrombus level and histological subtype. Kaplan-Meyer curves were used to assess survival. Overall, 67 patients underwent surgery for RCC with neoplastic tumoral thrombosis in the period under review. 60 were clear cell RCC, 4 were urothelial papillary tumors of the renal pelvis and 3 were rare histotypes, as a nefroblastoma, a spinocellular tumor of the renal pelvis and an unclassifiable renal carcinoma. Thrombus level was I in 40 cases, II in 17, III in 2 and IV in 8 patients. We report the main postoperative complications and our survival data, with mean follow up of 36 months. Tumor stage is the most important variable in predicting survival. Patients with N0M0 disease had 70% survival at 36 months, instead of 20% for those with primitive metastatic tumor. Our survival results fit with the main reports in literature and our surgical management was completely in keeping with international guidelines. We did not observe relevany post-operative complications, except of hemorrhagic ones that occurred in 6 patients (9% of total) and were always successfully managed. Eighteen patients (26.87% of total) underwent caval filter positioning, without evidence of complications during its positioning or removal. Life expectancy was particularly low for the cases of RCC without clear cell histotype (7 cases in our series, 10.4% of total) that always was less than one year from surgery.

Evaluation of ABO blood group as a prognostic marker in renal cell carcinoma (RCC)

To evaluate ABO blood group as a prognostic marker in patients with renal cell carcinoma (RCC). This retrospective study included 556 consecutive patients who underwent surgery for RCC at a single institution. The associations of ABO blood group with clinical and pathological variables were assessed using Kruskal-Wallis and chi-squared tests. The impact on overall survival (OS) and RCC-specific survival (RCC-SS) was analysed using univariable and multivariable Cox proportional hazards regression models. Blood group O was associated with the absence of lymph node metastases (P = 0.034) and the presence of bilateral RCC (P = 0.017). No associations with age, gender, body mass index, Charlson comorbidity index, T stage, M stage, grade and histological subtype were observed. In univariable and multivariable survival analysis, ABO blood group was not associated with OS and RCC-SS. In the present study, ABO blood group was not linked with RCC prognosis. Blood group O may be associated with the absence of lymph node metastases and the presence of bilateral RCC. External validation in larger cohorts is necessary.

P036 Functioning renal parenchyma score as an indicator of nephron-sparing surgery for renal cell carcinoma

P036 Functioning renal parenchyma score as an indicator of nephron-sparing surgery for renal cell carcinoma

C14 Incidence of local and port site recurrence after laparoscopic surgery for renal cell carcinoma

C14 Incidence of local and port site recurrence after laparoscopic surgery for renal cell carcinoma

Nephron-Sparing Surgery in Renal Cell Carcinoma: Morbidity and Outcomes

Objective: To present the partial nephrectomy series performed at our institution. Patients and Methods: 147 patients underwent nephron-sparing surgery between Jan/2000 and Feb/2011. The mean patient age was 60.3 yrs (33.2-82.7), and 90 (61.2%) were men. The clinical presentation, pathological tumor features, perioperative complications, functional and oncological outcomes were analyzed. Results: 84.4% of the renal masses were incidental, and the mean tumor size was 3,63 cm. Median warm ischemia time and estimated blood loss was 18 min (11-27) and 220 ml (50-480), respectively. Overall complication rate was 5%. 87.0% of the tumors were pT1, 5.7% were pT2, and 7.3% was pT3. 45 tumors were high-grade (30.6%), microvascular invasion was observed in eleven tumors (7.5%), presence of necrosis occurred in twenty-seven tumors (18.4%), and invasion of perirenal fat was identified in ten cases (6.8%). At a mean follow-up of 60 months, local recurrence was observed in only six cases (4.1%) and the cancer-specific survival in this series was 95.2%. Conclusion: Open partial nephrectomy is safe and presented optimal oncological results. It should be used for treating small renal tumors whenever is technically feasible.

Predictive factors for the development of chronic renal insufficiency after renal surgery: a multicenter study

To evaluate which factors affecting changes in postoperative renal function after conducting radical nephrectomy or partial nephrectomy. Data on patients who underwent operations for renal cell carcinoma between 2000 and 2010 at multiple institutions were collected. Patient characteristics including preoperative estimated glomerular filtration rate (EGFR) were investigated, and types of surgery and postoperative results were evaluated. Renal insufficiency was defined as an EGFR <60 ml/min/1.73 m(2). Cox proportional hazard regression analysis was used to investigate which factors were associated with chronic renal insufficiency after surgery. A total of 2,454 patients were included for evaluation; 1,502 patients underwent radical nephrectomy, whereas 952 patients underwent partial nephrectomy. The mean follow-up period was 44.48 ± 27.04 months (range, 12-120 months). Factors affecting EGFR were age, diabetes, hypertension, surgical procedure, and preoperative creatinine level (p < 0.001). Factors affecting postoperative renal insufficiency were age, surgical procedure, serum creatinine level, and EGFR. The risk for developing post-nephrectomy renal insufficiency in patients who underwent radical nephrectomy was higher than those who underwent partial nephrectomy. Factors affecting post-nephrectomy renal insufficiency were age, preoperative serum creatinine level, and preoperative EGFR. In addition to radical nephrectomy, patient >58 years with a preoperative serum creatinine >1.03 mg/ml, and EGFR <73 ml/min/1.73 m(2) had a higher probability of developing post-nephrectomy chronic renal insufficiency.