Nephron-sparing surgery for localized renal cell carcinoma (RCC) may decrease the risk of cancer-specific mortality (CSM) in a subset of patients, according to a new study.
In a single-center study of 1767 patients who underwent either partial or radical nephrectomy for RCC, investigators from the University of Brescia in Italy observed an inverse relationship between estimated glomerular filtration rate (eGFR) and CSM among patients with organ-confined RCC whose eGFR decreases below 85 mL/min/1.73 m2. In this group, each 10 mL/min/1.73 m2 decrease in eGFR was associated with a 27% increased risk of CSM in an adjusted analyses, Alessandro Antonelli, MD, and colleagues reported in Clinical Genitourinary Cancer. The study found no significant association between eGFR and CSM among patients with eGFR values above 85 mL/min/1.73 m2 or among those with stage III to IV RCC.
“The relationship found between eGFR and CSM indicates that renal function could exert an oncologic role in patients undergoing surgery for TNM stage I to II RCC,” the authors concluded. “In such conditions, whenever feasible, nephron-sparing approaches should be preferred, unless extirpative surgery could equally warrant the preservation of renal function above specific limits.”
The authors noted that the “hypothesis that the impairment of renal function may impact CSM has been poorly acknowledged.” Evidence suggests, however, that chronic kidney disease, “even at an early stage, may worsen the response against cancer.”
Of the 1767 patients in the study, 1298 (73.4%) had stage I to II disease and 459 (26.6%) had stage III to IV disease; 752 patients (42.5%) underwent partial nephrectomy and 1015 (57.5%) underwent radical nephrectomy. Patients had a median age of 66 years, and 1127 (63.8%) were male. Their median eGFR at diagnosis was 88 mL/min/1.73 m2. At the last follow-up, 1491 patients (84.3%) were still alive, 131 (7.4%) died from RCC, and 145 (8.2%) died from other causes. The median follow-up for patients who were still alive was 64 months.
Antonelli A, Palumbo C, Sandri M, et al. Renal function impairment below safety limits correlates with cancer-specific mortality in localized renal cell carcinoma: Results from a single-center study [published online December 13, 2019]. Clin Genitourin Cancer. doi: 10.1016/j.clgc.2019.12.005