Nephron-sparing surgery may improve survival in some renal cancer patients

NEW YORK (Reuters Health) - New research suggests that preserving as much tissue as possible during nephrectomy may enhance the survival of renal cancer patients with reduced kidney function at baseline.

"Since many studies have shown no difference in survival from cancer when only part of the kidney is removed compared to when the entire kidney is removed, this work raises the question about whether the treatment may be more harmful than the cancer in some cases," lead author Dr. Joseph A. Pettus, from Wake Forest University Baptist Hospital in Winston-Salem, North Carolina, told Reuters Health.

"The take-home message here is that preoperative glomerular filtration rate (GFR) impacts survival, and we should do whatever we can to try and preserve kidney function when managing kidney tumors."

The results, which appear in the Mayo Clinic Proceedings for October, are based on a study of 1479 patients who underwent partial or radical nephrectomy for a localized renal tumor. The patients were treated at Memorial Sloan Kettering Cancer Center in New York from January 4, 1995 to June 9, 2005.

During the study period, the patients' median body mass index increased from 27 to 28 and the baseline estimated GFR dropped from 70 to 63 mL/min/1.73 meters-squared. Multivariate analysis confirmed a significant association between year of surgery and baseline estimated GFR (p < 0.001).

After accounting for disease stage, baseline estimated GFR, body mass index, and comorbidity were not significantly linked to disease-free survival.

However, moderately (45 to 65 mL/min/1.73 meters-squared) and severely reduced (<45 mL/min/1.73 meters-squared) estimated GFR did increase mortality by 1.5- and 2.8-fold, respectively.

"Our findings were surprising because they suggest that, with the exception of advanced cancers, preoperative GFR can have a bigger impact on survival after surgery than the cancer itself," Dr. Pettus noted.

"These findings," the authors conclude, "underscore the importance of considering baseline estimated GFR when devising treatment plans for renal cell tumors, especially among patients with serious comorbidity."

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