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Renal Function and Cancer-Specific Mortality in Renal Cell Carcinoma

By: Joseph Fanelli
Posted: Monday, January 28, 2019

Based on the findings of a retrospective analysis of nearly 3,500 patients who underwent radical or partial nephrectomy for renal cell carcinoma, Alessandro Antonelli, MD, of the University of Brescia, Italy, and colleagues observed a link between glomerular filtration rate and cancer-specific mortality. They believe their study results, which were published in European Urology, indicate renal function should be preserved to improve cancer-related survival.

Dr. Antonelli’s team performed a retrospective analysis of 3,457 patients who had surgery for cT1–2 renal cell carcinoma; 39% underwent radical nephrectomy and 61% had partial nephrectomy. The estimated glomerular filtration rate (eGFR) was calculated by the Chronic Kidney Disease Epidemiology Collaboration equation, and cancer-specific mortality was analyzed in a multivariable competing-risk framework. Nearly two-thirds of patients had both preoperative and postoperative measurements. The median eGFR was 78.5 mL/minute at baseline, 71.4 mL/min after 12 months, and 64.4 mL/min at the last functional follow-up.

The investigators identified a cutoff of 65 mL/min with eGFR as a time-dependent covariate and 85, 60, and 65 mL/min with eGFR as a time-fixed covariate at baseline, 12 months, and last functional follow-up, respectively. “In multivariable competing-risk analysis, [cancer-specific mortality] was associated with eGFR only for values of eGFR below these cutoffs, with [subdistribution hazard ratios] for every 10 mL/min of reduction in eGFR of 1.25 (P = .003), 1.16 (P = .028), 1.44 (P = .02), and 1.16 (P = .042) corresponding to time-dependent eGFR, and eGFR at baseline, 12 months, and last functional follow-up, respectively,” they reported.

Disclosure: The study authors’ disclosure information may be found at europeanurology.com.



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