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Perioperative Change in Renal Function: Prognostic Indicator in Renal Cell Carcinoma?

By: Melissa Steele-Ogus
Posted: Monday, March 16, 2020

Radical nephrectomy with thrombectomy is considered the best course of treatment for renal cell carcinoma. Loss of renal tissue, however, is not without complications, and many patients do not completely recover renal function after surgery. Previous studies have used preoperative estimated glomerular filtration rate (eGFR) to predict postoperative renal function; a recent Chinese study, published in BMC Cancer, investigated perioperative renal function as a similar predictive tool. The study was conducted by Zhuo Liu, MD, and colleagues from Peking University Third Hospital, Beijing.

The patient population was comprised of 101 male patients and 24 female patients diagnosed with renal cell carcinoma and tumor thrombus who underwent nephrectomy and thrombectomy. To assess kidney function, the researchers measured patients’ eGFR 1 week before and 1 month after surgery; these numbers were then used to calculate absolute change in eGFR and percent change in eGFR. Tumor type and grade were determined through histology.

In total, 115 patients were determined to have clear cell carcinoma, and 20 patients had other histologic types. During the course of the study, 22 patients with renal carcinoma died. The mean preoperative eGFR was 73.9 ± 21.8 mL/(min × 1.73 m2), and the postoperative eGFR mean was 69.5 ± 25.2 mL/(min × 1.73 m2). A greater decreased renal function after surgery was correlated with a greater change in eGFR. Furthermore, there appeared to be a relationship between preoperative eGFR and the presence of non–clear cell carcinoma. A poorer cancer-specific survival prognosis was correlated with an absolute chance in eGFR greater than 13.9 and percent change in e GFR greater than 0.16.

“We expect a new more complex index including all prognostic predictors in assessing the change of perioperative renal function of patients following [radical nephrectomy] with thrombectomy in the future,” Dr. Liu and colleagues concluded.

Disclosure: The authors reported no conflicts of interest.

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