Multiple factors influence decision making for the surgical treatment in patients with renal cell carcinoma

Britt-Inger Kröger Dahlin; Jan Hlodan; Ramin Ghaffarpour; Börje Ljungberg

doi:10.2340/sju.v59.25517

Authors

Britt-Inger Kröger Dahlin Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
Jan Hlodan Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
Ramin Ghaffarpour Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
Börje Ljungberg Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden

DOI:

https://doi.org/10.2340/sju.v59.25517

Keywords:

Renal Cell Carcinoma, Renal tumor, kidney function, estimated glomerular filtration rate, WHO peformance status, Charlson comorbidity index, T-stage, M-stage, tumor size, radical nephrectomy, partial nephrectomy

Abstract

Background: Surgical strategy in renal cell carcinoma (RCC) is considered based on the renal function. Partial nephrectomy (PN) preserves kidney function better than radical nephrectomy (RN), lowering risk of chronic kidney disease (CKD). The aim was to evaluate whether renal function and other clinical variables were important for surgical treatment selection.

Methods: Patients with RCC, surgically treated between 1994 and 2018 were included. There were 663 patients in all stages, 265 women and 398 men, mean age 66 years. Clinical data: estimated glomerular filtration rate (eGFR), WHO performance status (WHO-PS), Charlson comorbidity index (CCI), surgery, T-stage, M-stage, RCC type, tumor size, age, and gender were extracted from the medical records. Statistical analysis included Mann-Whitney U, X2-test, and logistic regression analysis.

Results: Of 663 patients, 455 were treated with RN and 208 with PN. In all patients, preoperative eGFR was significantly higher in PN (80.8) than in RN (77.1, p = 0.015). Using logistic regression tumor size (odds ratio [OR]: 0.96; 95% confidence interval [CI]: 0.95–0.98, T-stage (OR: 0.46; 95% CI: 0.33–0.65), WHO-PS (OR: 0.39; 95% CI: 0.04–0.57), and CCI (OR: 1.23; 95% CI: 1.05–1.44), associated to treatment selection, while eGFR, M-stage, age, and gender did not.

In cTa subgroup, eGFR was also higher in PN (84.6) than in RN (75.0, p = 0.007). Using logistic regression, tumor size (OR: 0.93; 95% CI: 0.83–0.98) and WHO-PS (OR: 0.36; 95% CI: 0.20–0.66) associated to treatment selection, while eGFR, CCI, age, and gender did not.

Conclusion: Tumor size, CCI scores, T-stage, and WHO-PS, all had an impact on the surgical strategy for all RCC patients. In patients with T1a RCC, tumor size and WHO-PS associated independently with treatment decision. After adjusted analysis, renal function lost its independent association with the treatment strategy in RCC patients.

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