Introduction:
Radical nephrectomy (RN) remains a standard of care approach for management of complex and large renal masses with excellent oncological outcomes. While funcitonal decline post-RN is a well documented phenomenon, complete functional recovery post-RN and its impact on survival outcomes is poorly understood. We sought to investigate outcomes of, and identify and characterize factors contributing to, complete functional recovery in RN.
Methods:
We conducted a retrospective multicenter analysis of patients who underwent open or minimally-invasive RN for localized (T1-3N0M0) Renal Cell Carinoma (RCC) who did not have preoperative chronic kidney disease (CKD). Post-RN "complete functional recovery" (CFR) was defined as less than or equal to 10% decline in eGFR (ΔeGFR) from preoperative baseline eGFR to last follow-up (ΔeGFR≤10%), calculated by CKD-EPI 2021 equation. CKD was defined as eGFR<60 mL/min/1.73m2. Logistic regression was performed to identify factors associated with CFR, and Cox regression multivariable analysis (MVA) was performed to identify factors associated with all-cause mortality (ACM). Kaplan-Meier analysis (KMA) assessed 5-year overall survival (OS) comparing ΔeGFR≤10%, ΔeGFR>10% and ≤50%, and ΔeGFR>50%.
Results:
We analyzed 2584 patients with preoperative eGFR>60 mL/min/1.73m2. CFR/ΔeGFR≤10% was observed in 366 (14.2%). ΔeGFR>10% and ≤50% was noted in 1,934 patients (74.8%), and ΔeGFR>50% was noted in 280 patients (10.8%). Younger age (OR=1.03, p<0.001), Asian (OR=2.33, p<0.001), Latin (OR=1.43, p<0.001), chromophobe-RCC (OR=1.22, p=0.008) were predictive CFR. CFR (HR=0.45, p<0.001) and Asian ethnicity (HR=0.53, p<0.001) were associated with decreased risk of ACM, while increasing age (HR=1.03, p<0.001), tumor size (HR=1.07, p<0.001), and stage (HR=1.54-5.71, p<0.001) were associated with increased ACM. KMA comparing CFR with patients with ΔeGFR>10% and ≤50% and ΔeGFR>50% demonstrated 5-year OS of 78.5%, 47.4%, and 13.3% (p<0.001).
Conclusion:
A small but significant proportion of patients experience CFR post-RN. Preservation of eGFR was associated with improved OS, ACM, while achievement of CFR was more likely to occur in Asian and Latin patients and patients with chromophobe-RCC. Identificaton of patients more likely to achieve CFR may obviate increased risk of complex nephron-sparing procedures in select patients, while achieving good oncological outcomes. Further investigations are needed.
Funding: N/A
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PREVALENCE, PREDICTORS AND OUTCOMES OF "COMPLETE FUNCTIONAL RECOVERY" AFTER RADICAL NEPHRECTOMY: ANALYSIS OF THE INMARC REGISTRY
Category
Kidney Cancer > Clinical
Description
Poster #144
Presented By: Kit L. Yuen
Authors:
Kit L. Yuen
Giacomo Musso
Cesare Saitta
Yasuhisa Fujii
Edouard Nicaise
Riccardo Autorino
Andrea Minervini
Gabriele Tuderti
Giuseppe Simone
Riccardo Campi
Clara Cerrato
Antonio Franco
Aaron Ahdoot
Dhruv Puri
Mimi V Nguyen
Margaret Meagher
Jacob Roberts
Jonathan A Afari
Luke Wang
Melissa Guers
Kevin Hakimi
Franklin Liu
Alberto Briganti
Alessandro Larcher
Umberto Capitanio
Andrea Salonia
Chen Wei
Francesco Montorsi
Nahar Imtiaz
Dattatraya Patil
Kobayashi Masaki
Kazutaka Saito
Fukuda Shohei
Hajime Tanaka
Viraj Master
Ithaar H. Derweesh