Predictors of Long-Term Survival after Renal Cancer Surgery

Joseph Zabell, Sevag Demirjian, Brian R. Lane, Ithaar H. Derweesh, Sudhir Isharwal, Chalairat Suk-Ouichai, Jitao Wu, Diego Aguilar Palacios, Steven C. Campbell

Research output: Contribution to journalArticle

7 Scopus citations

Abstract

Purpose Renal cancer surgery can adversely impact long-term function and survival. We evaluated predictors of chronic kidney disease 5 years and nonrenal cancer mortality 10 years after renal cancer surgery. Materials and Methods We analyzed the records of 4,283 patients who underwent renal cancer surgery from 1997 to 2008. Radical and partial nephrectomy were performed in 46% and 54% of patients, respectively. Cumulative probability ordinal modeling was used to predict chronic kidney disease status 5 years after surgery and multivariable logistic regression was used to predict nonrenal cancer mortality at 10 years. Relevant patient, tumor and functional covariates were incorporated, including the preoperative glomerular filtration rate (A), the new baseline glomerular filtration rate after surgery (B) and the glomerular filtration rate loss related to surgery (C), that is C = A – B. In contrast, partial or radical nephrectomy was not used in the models due to concerns about strong selection bias associated with the choice of procedure. Results Multivariable modeling established the preoperative glomerular filtration rate and the glomerular filtration rate loss related to surgery as the most important predictors of the development of chronic kidney disease (Spearman ρ = 0.78). Age, gender and race had secondary roles. Significant predictors of 10-year nonrenal cancer mortality were the preoperative glomerular filtration rate, the new baseline glomerular filtration rate, age, diabetes and heart disease (all p <0.05). Multivariable modeling established age and the preoperative glomerular filtration rate as the most important predictors of 10-year nonrenal cancer mortality (c-index 0.71) while the glomerular filtration rate loss related to surgery only changed absolute mortality estimates 1% to 3%. Conclusions Glomerular filtration rate loss related to renal cancer surgery, whether due to partial or radical nephrectomy, influences the risk of chronic kidney disease but it may have less impact on survival. In contrast, age and the preoperative glomerular filtration rate, which reflects general health status, are more robust predictors of nonrenal cancer mortality, at least in patients with good preoperative function or mild chronic kidney disease.

Original languageEnglish (US)
Pages (from-to)384-392
Number of pages9
JournalJournal of Urology
Volume199
Issue number2
DOIs
StatePublished - Feb 1 2018
Externally publishedYes

Keywords

  • chronic
  • glomerular filtration rate
  • kidney failure
  • kidney neoplasms
  • mortality
  • nephrectomy

ASJC Scopus subject areas

  • Urology

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  • Cite this

    Zabell, J., Demirjian, S., Lane, B. R., Derweesh, I. H., Isharwal, S., Suk-Ouichai, C., Wu, J., Palacios, D. A., & Campbell, S. C. (2018). Predictors of Long-Term Survival after Renal Cancer Surgery. Journal of Urology, 199(2), 384-392. https://doi.org/10.1016/j.juro.2017.08.096