Antonelli, A.

Bertini, R.

Capitanio, U.

Carini, Marco

Castiglione, F.

Furlan, M.

Minervini, Andrea

Simeone, Felice Carlo

Terrone, C.

Volpe, A.

English

Florence Research

651 Renal function impairment after nephron sparing surgery or radical nephrectomy in patientswith clinical T1a-T1b renal mass and normal preoperative glomerular filtration rates: Resultsfrom a large multi-institutional studyEur Urol Suppl 2014;13;e651         Print!Capitanio U.1, Terrone C.2, Antonelli  A.3, Minervini A.4, Volpe A.2, Castiglione F.1, Furlan M.3, Matloob R.1, Regis F.2, Zegna L.2, VittoriG.4, Di Trapani E.1, Carini M.4, Simeone C.3, Bertini R.11San Raffaele Scientific Institute, Dept. of Urology, Milan, Italy, 2University of Piemonte Orientale, Dept. of Urology, Novara, Italy,3Universita' Degli Studi E Spedali Civili Di Brescia, Dept. of Urology, Brescia, Italy, 4Clinica Urologica I, Azienda Ospedaliera UniversitariaCareggi, Università Degli Studi Di Firenze., Dept. of Urology, Florence, ItalyINTRODUCTION & OBJECTIVES: Some reports suggested that nephron sparing surgery (NSS) may protect against renal functionimpairment (RFI) when compared with radical nephrectomy (RN) in patients with small renal masses. In the current study, we aimed to testthe effect of treatment type (NSS vs. RN) on prevalence of RFI and renal end-stage kidney disease (ESRD) after accounting for clinicalcharacteristics, comorbidities and individual cardiovascular risk.MATERIAL & METHODS: A multi-institutional collaboration among four European Tertiary Care Centres allowed collecting 2024 patientswith a clinical T1a-T1b N0 M0 renal mass and complete functional follow-up data. Patients underwent RN (n=765, 37.8%) or NSS (n=1259,62.2%) and showed normal estimated glomerular filtration rates (eGFR) before surgery (defined as a pre-operative eGFR≥60 milliliters perminute per 1.73 m2). Descriptive, univariable and multivariable Cox regression analyses predicting RFI were performed. To adjust forinherent baseline differences among patients, we included as covariates: preoperative creatinine, age, clinical tumour size, gender,presence of hypertension or diabetes at diagnosis, baseline Charlson comorbidity index (CCI), body mass index and smoker status.RESULTS: Mean patient age resulted 60.6 years (median 62). Mean body mass index resulted 26 kg/m2. Overall, 20.0% and 9.9% of thepatients had uncontrolled hypertension or diabetes, respectively. CCI resulted 0-1 in 71.9% of the patients. At a mean follow up period of68.2 months, 81.1% vs. 55.8% patients showed normal renal function after NSS vs. RN, respectively (p<0.001). The prevalence of mild RFI,severe RFI and ESRD resulted 25.3, 1.0% and 2.1%. However, after stratifying for treatment type, the prevalence of mild RFI, severe RFIand ESRD resulted higher in the group of patients treated with RN relative to NSS (39.7 vs. 16.6%, 1.4 vs. 0.8% and 3.0 vs. 1.5%,respectively, p<0.001). At multivariable analyses, patients who underwent PN showed significantly lower risk to harbour RFI compared withtheir RN-treated counterparts (hazard ratio [HR]: 0.63; 95% confidence interval, 0.44-0.89; p=0.008). Increasing age (HR: 1.06, p<0.001),larger tumours (HR: 1.04, p<0.001), presence of hypertension (HR: 5.39, p=0.006) and presence of diabetes (HR: 1.56, p=0.05) resultedindependent predictors of RFI.CONCLUSIONS: Although the risk of severe renal function impairment and ESRD is negligible, up to 30% of the patients with clinical T1a-T1b renal masses and a normal preoperative kidney function harbour mild RFI after surgery. Also after accounting for clinicalcharacteristics, comorbidities and cardiovascular risk at diagnosis, NSS significantly decrease the risk of RFI relative to RN.

Renal function impairment after nephron sparing surgery or radical nephrectomy in patients

with clinical T1a-T1b renal mass and normal preoperative glomerular filtration rates: Results

from a large multi-institutional study

https://flore.unifi.it/bitstream/2158/1056746/1/Capitanio_2014_European-Urology-Supplements.pdf

Renal function impairment after nephron sparing surgery or radical nephrectomy in patients with clinical T1a-T1b renal mass and normal preoperative glomerular filtration rates: Results from a large multi-institutional study

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