Login to Access Video or Poster Abstract: MP59-15
Sources of Funding: None

Introduction

Renal cancer surgery can adversely impact long-term renal function and survival. We evaluate predictors of 5-year risk of chronic kidney disease (CKD) and 10-year risk of non-renal cancer mortality (NRCM) after renal cancer surgery (RCS).

Methods

We analyzed 4,283 patients undergoing RCS at Cleveland Clinic between 1997 and 2008. Radical nephrectomy (RN) was performed in 1,982 patients (46%) and 2,301 (54%) underwent partial nephrectomy (PN). Cumulative probability ordinal modeling was used to predict varying levels of CKD (defined as glomerular filtration rate (GFR) <45, <30, or <15 ml/min/1.73m2) at 5 years after surgery. Multivariable logistic regression was used to develop a separate model predicting NRCM at 10 years postoperatively. Race, gender, preoperative GFR, new baseline GFR, and relevant clinical comorbidities were included in the models. Preoperative GFR, new baseline GFR, and GFR loss following surgery were included in the models, rather than type of surgery (PN vs RN), to reduce potential selection biases associated with choice of surgical procedure.

Results

Median age was 62 years (IQR=52-71). Significant predictors for 5-year CKD were preoperative GFR, GFR loss at 6 weeks post-op, male gender, age, and African-American race (all p<0.05). A predictive nomogram was created from the multivariable model (Spearman rho of 0.779) demonstrating preoperative GFR and GFR loss at 6 weeks post-op as the most important predictive factors. 10-year overall risk of NRCM was 29%. Significant predictors of NRCM were preoperative GFR, new baseline GFR, age, diabetes, and hypertension (all p<0.05). A predictive nomogram for 10-year NRCM was created with a c-index 0.71, demonstrating age and preoperative GFR as the most important predictive factors. GFR loss with surgery, as would be seen with typical PN vs. RN, only changed absolute mortality risk by 1-3% in nomogram-based examples (see Figure).

Conclusions

GFR loss with RCS, which is directly related to choice of PN vs RN, strongly influences risk of developing CKD, but has much less impact on long-term survival. In contrast, age and preoperative GFR are much more robust predictors of 10-year NRCM.

Funding

None