Analysis of Renal Functional Outcomes after Radical or Partial Nephrectomy for Renal Masses ≥7 cm Using the RENAL Score

Ryan P. Kopp, Michael A. Liss, Reza Mehrazin, Song Wang, Hak J. Lee, Ramzi Jabaji, Hossein S. Mirheydar, Kyle Gillis, Nishant Patel, Kerrin L. Palazzi, Jim Y. Wan, Anthony L. Patterson, Ithaar H. Derweesh

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39 Scopus citations

Abstract

Objective To determine if partial nephrectomy (PN) confers a renal functional benefit compared to radical nephrectomy (RN) for clinical T2 renal masses (T2RM) when adjusting for tumor complexity characterized by the RENAL nephrometry score. Methods A 2-center study of 202 patients with T2RM undergoing RN (122) or PN (80) (median follow-up, 41.5 months). RN and PN cohorts were subanalyzed according to RENAL sum as a categorical variable of <10 or ≥10. Primary outcome was median change in estimated glomerular filtration rate (ΔeGFR) between preoperative to 6 months postoperative. Logistic regression-identified prognostic factors and survival models analyzed association between the RENAL sum and the freedom from de novo chronic kidney disease (CKD; eGFR<60 mL/min/1.73m2). Results No significant differences existed between PN and RN for RENAL score. ΔeGFR was greater in RN (-19.7) vs PN (-11.9; P =.006). De novo CKD was 40.2% after RN vs 16.3% after PN (P <.001). RENAL score ≥10 (odds ratio, 6.67; P =.025) and RN among patients with RENAL score <10 (odds ratio, 24.8; P <.001) were independently associated with de novo CKD at 6 months by logistic regression. Among patients with RENAL score <10, median CKD-free survival was PN 38 vs RN 16 months (P =.001). Cox proportional hazard demonstrated decreasing risk of CKD for PN vs RN from RENAL 10 (hazard ratio, 0.836) to RENAL 6 (hazard ratio, 0.003; P =.001). Conclusion RN is independently associated with decreased renal function compared to PN for T2RM with RENAL sum ≤10, but not >10, with larger relative decrease in eGFR for each decrease in RENAL sum. Further investigation is required to determine optimal candidates for PN in T2RM.

Original languageEnglish (US)
Pages (from-to)312-320
Number of pages9
JournalUrology
Volume86
Issue number2
DOIs
StatePublished - Aug 1 2015

ASJC Scopus subject areas

  • Urology

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    Kopp, R. P., Liss, M. A., Mehrazin, R., Wang, S., Lee, H. J., Jabaji, R., Mirheydar, H. S., Gillis, K., Patel, N., Palazzi, K. L., Wan, J. Y., Patterson, A. L., & Derweesh, I. H. (2015). Analysis of Renal Functional Outcomes after Radical or Partial Nephrectomy for Renal Masses ≥7 cm Using the RENAL Score. Urology, 86(2), 312-320. https://doi.org/10.1016/j.urology.2015.02.067