Age-Related Differences in Oncological Outcomes in Renal Cell Carcinoma: Impact of Functional Conservation as Measured by Postoperative eGFR.

Autor: Yuan, Julia H., Tanaka, Hajime, Patil, Dattatraya, Hakimi, Kevin, Soliman, Shady, Meagher, Margaret F., Saidian, Ava, Walia, Arman, Dhanji, Sohail, Liu, Franklin, Afari, Jonathan, Nguyen, Mimi, Wang, Luke, Yasuda, Yosuke, Saito, Kazutaka, Fujii, Yasuhisa, Master, Viraj, Derweesh, Ithaar H.
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Zdroj: Clinical Genitourinary Cancer; Aug2023, Vol. 21 Issue 4, pe219-e227, 9p
Abstrakt: We sought to determine whether postnephrectomy loss of renal function increases risk of recurrence and mortality in renal cell carcinoma. Retrospective analysis of 1805 patients from the International Marker Consortium for Renal Cancer registry shows de novo eGFR < 45 mL/min/1.73m2 is independently associated with progression and worsened mortality in patients aged < 65 years, underscoring desirability for nephron preservation in younger patients. Introduction: We sought to determine whether loss of renal function increases risk of recurrence and metastases in renal cell carcinoma (RCC), and whether this impact was age-related. Materials and Methods: We performed a retrospective analysis of the International Marker Consortium for Renal Cancer (INMARC) registry. Patients were separated into younger (< 65 years old) and elder (=65 years old) age groups, and rates of de novo estimated glomerular filtration rate (eGFR < 45 mL/min/1.73m2 [eGFR < 45]) were calculated. Multivariable analysis (MVA) was conducted for predictors of progression-free survival (PFS) and all-cause mortality (ACM). Kaplan-Meier Analysis (KMA) was conducted for PFS and overall survival (OS) in younger and elder age groups stratified by functional status. Results: We analyzed 1805 patients (1113 age < 65, 692 age =65). On MVA in patients < 65, de novo eGFR < 45 was independently associated with greater risk for worsened progression (HR = 1.61, P = .038) and ACM (HR = 1.82, P = .018). For patients =65, de novo eGFR < 45 was not independently associated with progression (P = .736), or ACM (P = .286). Comparing patients with de novo eGFR < 45 vs. eGFR =45, KMA demonstrated worsened 5-year PFS and OS in patients < 65 (PFS: 68% vs. 86%, P < .001; OS: 73% vs. 90%, P < .001), while in patients =65, only 5-year OS was worsened (77% vs. 81%, P < .021). Conclusion: Development of de novo eGFR < 45 was associated with more profound impact on patients < 65 compared to patients =65, being an independent risk factor for PFS and ACM. The mechanisms of this phenomenon are unclear but underscore desirability for nephron preservation when safe and feasible in younger patients. [ABSTRACT FROM AUTHOR]
Databáze: Complementary Index
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