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Analysis of Renal Functional Outcomes After Radical or Partial Nephrectomy for Renal Masses ≥7 cm Using the RENAL Score
Objective To determine if partial nephrectomy (PN) confers a renal functional benefit compared to radical nephrectomy (RN) for clinical T2 renal masses (T2RM) when adjusting for tumor complexity characterized by the RENAL nephrometry score. Methods A 2-center study of 202 patients with T2RM undergoi...
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Published in: | Urology (Ridgewood, N.J.) N.J.), 2015-08, Vol.86 (2), p.312-320 |
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creator | Kopp, Ryan P Liss, Michael A Mehrazin, Reza Wang, Song Lee, Hak J Jabaji, Ramzi Mirheydar, Hossein S Gillis, Kyle Patel, Nishant Palazzi, Kerrin L Wan, Jim Y Patterson, Anthony L Derweesh, Ithaar H |
description | Objective To determine if partial nephrectomy (PN) confers a renal functional benefit compared to radical nephrectomy (RN) for clinical T2 renal masses (T2RM) when adjusting for tumor complexity characterized by the RENAL nephrometry score. Methods A 2-center study of 202 patients with T2RM undergoing RN (122) or PN (80) (median follow-up, 41.5 months). RN and PN cohorts were subanalyzed according to RENAL sum as a categorical variable of |
doi_str_mv | 10.1016/j.urology.2015.02.067 |
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Methods A 2-center study of 202 patients with T2RM undergoing RN (122) or PN (80) (median follow-up, 41.5 months). RN and PN cohorts were subanalyzed according to RENAL sum as a categorical variable of <10 or ≥10. Primary outcome was median change in estimated glomerular filtration rate (ΔeGFR) between preoperative to 6 months postoperative. Logistic regression–identified prognostic factors and survival models analyzed association between the RENAL sum and the freedom from de novo chronic kidney disease (CKD; eGFR<60 mL/min/1.73m2 ). Results No significant differences existed between PN and RN for RENAL score. ΔeGFR was greater in RN (−19.7) vs PN (−11.9; P = .006). De novo CKD was 40.2% after RN vs 16.3% after PN ( P <.001). RENAL score ≥10 (odds ratio, 6.67; P = .025) and RN among patients with RENAL score <10 (odds ratio, 24.8; P <.001) were independently associated with de novo CKD at 6 months by logistic regression. Among patients with RENAL score <10, median CKD-free survival was PN 38 vs RN 16 months ( P = .001). Cox proportional hazard demonstrated decreasing risk of CKD for PN vs RN from RENAL 10 (hazard ratio, 0.836) to RENAL 6 (hazard ratio, 0.003; P = .001). Conclusion RN is independently associated with decreased renal function compared to PN for T2RM with RENAL sum ≤10, but not >10, with larger relative decrease in eGFR for each decrease in RENAL sum. Further investigation is required to determine optimal candidates for PN in T2RM.]]></description><identifier>ISSN: 0090-4295</identifier><identifier>EISSN: 1527-9995</identifier><identifier>DOI: 10.1016/j.urology.2015.02.067</identifier><identifier>PMID: 26189330</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Carcinoma, Renal Cell - pathology ; Carcinoma, Renal Cell - surgery ; Female ; Humans ; Kidney - physiology ; Kidney Function Tests ; Kidney Neoplasms - pathology ; Kidney Neoplasms - surgery ; Male ; Middle Aged ; Nephrectomy - methods ; Recovery of Function ; Retrospective Studies ; Tumor Burden ; Urology</subject><ispartof>Urology (Ridgewood, N.J.), 2015-08, Vol.86 (2), p.312-320</ispartof><rights>Elsevier Inc.</rights><rights>2015 Elsevier Inc.</rights><rights>Copyright © 2015 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c420t-6931d179d0439c126e690d970569a2ab8df86858f3c3733a019910a9d280f2c53</citedby><cites>FETCH-LOGICAL-c420t-6931d179d0439c126e690d970569a2ab8df86858f3c3733a019910a9d280f2c53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790,27957,27958</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26189330$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kopp, Ryan P</creatorcontrib><creatorcontrib>Liss, Michael A</creatorcontrib><creatorcontrib>Mehrazin, Reza</creatorcontrib><creatorcontrib>Wang, Song</creatorcontrib><creatorcontrib>Lee, Hak J</creatorcontrib><creatorcontrib>Jabaji, Ramzi</creatorcontrib><creatorcontrib>Mirheydar, Hossein S</creatorcontrib><creatorcontrib>Gillis, Kyle</creatorcontrib><creatorcontrib>Patel, Nishant</creatorcontrib><creatorcontrib>Palazzi, Kerrin L</creatorcontrib><creatorcontrib>Wan, Jim Y</creatorcontrib><creatorcontrib>Patterson, Anthony L</creatorcontrib><creatorcontrib>Derweesh, Ithaar H</creatorcontrib><title>Analysis of Renal Functional Outcomes After Radical or Partial Nephrectomy for Renal Masses ≥7 cm Using the RENAL Score</title><title>Urology (Ridgewood, N.J.)</title><addtitle>Urology</addtitle><description><![CDATA[Objective To determine if partial nephrectomy (PN) confers a renal functional benefit compared to radical nephrectomy (RN) for clinical T2 renal masses (T2RM) when adjusting for tumor complexity characterized by the RENAL nephrometry score. Methods A 2-center study of 202 patients with T2RM undergoing RN (122) or PN (80) (median follow-up, 41.5 months). RN and PN cohorts were subanalyzed according to RENAL sum as a categorical variable of <10 or ≥10. Primary outcome was median change in estimated glomerular filtration rate (ΔeGFR) between preoperative to 6 months postoperative. Logistic regression–identified prognostic factors and survival models analyzed association between the RENAL sum and the freedom from de novo chronic kidney disease (CKD; eGFR<60 mL/min/1.73m2 ). Results No significant differences existed between PN and RN for RENAL score. ΔeGFR was greater in RN (−19.7) vs PN (−11.9; P = .006). De novo CKD was 40.2% after RN vs 16.3% after PN ( P <.001). RENAL score ≥10 (odds ratio, 6.67; P = .025) and RN among patients with RENAL score <10 (odds ratio, 24.8; P <.001) were independently associated with de novo CKD at 6 months by logistic regression. Among patients with RENAL score <10, median CKD-free survival was PN 38 vs RN 16 months ( P = .001). Cox proportional hazard demonstrated decreasing risk of CKD for PN vs RN from RENAL 10 (hazard ratio, 0.836) to RENAL 6 (hazard ratio, 0.003; P = .001). Conclusion RN is independently associated with decreased renal function compared to PN for T2RM with RENAL sum ≤10, but not >10, with larger relative decrease in eGFR for each decrease in RENAL sum. Further investigation is required to determine optimal candidates for PN in T2RM.]]></description><subject>Carcinoma, Renal Cell - pathology</subject><subject>Carcinoma, Renal Cell - surgery</subject><subject>Female</subject><subject>Humans</subject><subject>Kidney - physiology</subject><subject>Kidney Function Tests</subject><subject>Kidney Neoplasms - pathology</subject><subject>Kidney Neoplasms - surgery</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Nephrectomy - methods</subject><subject>Recovery of Function</subject><subject>Retrospective Studies</subject><subject>Tumor Burden</subject><subject>Urology</subject><issn>0090-4295</issn><issn>1527-9995</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><recordid>eNqFkcFu1DAQhiMEokvhEUA-ckkY22snvoBWVQtIS4u29Gy5zqT1ksRbO0GKeALeohdepI_Ck-BoFw5cOHk8-v8Zzfdn2UsKBQUq32yLMfjW30wFAyoKYAXI8lG2oIKVuVJKPM4WAAryJVPiKHsW4xYApJTl0-yISVopzmGRfV_1pp2ii8Q3ZIPpQ87G3g7Oz-XFOFjfYSSrZsBANqZ2NrV9IJ9NGFwqz3F3G9AOvptIk_r7EZ9MjBgf7n_9-Fk-3NuOXEXX35DhFsnm9Hy1JpfWB3yePWlMG_HF4T3Ors5Ov5x8yNcX7z-erNa5XTIYcqk4rWmpalhyZSmTKBXUqgQhlWHmuqqbSlaiarjlJecGqFIUjKpZBQ2zgh9nr_dzd8HfjRgH3blosW1Nj36MmpYgRVkqypNU7KU2-BgDNnoXXGfCpCnombve6gN3PXPXwHTinnyvDivG6w7rv64_oJPg3V6A6dBvDoOO1mFvsXYzPl17998Vb_-ZYFvXz3l8xQnj1o8hoU_X6JgM-nIOf86eCgAuJfDf3xitHQ</recordid><startdate>20150801</startdate><enddate>20150801</enddate><creator>Kopp, Ryan P</creator><creator>Liss, Michael A</creator><creator>Mehrazin, Reza</creator><creator>Wang, Song</creator><creator>Lee, Hak J</creator><creator>Jabaji, Ramzi</creator><creator>Mirheydar, Hossein S</creator><creator>Gillis, Kyle</creator><creator>Patel, Nishant</creator><creator>Palazzi, Kerrin L</creator><creator>Wan, Jim Y</creator><creator>Patterson, Anthony L</creator><creator>Derweesh, Ithaar H</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20150801</creationdate><title>Analysis of Renal Functional Outcomes After Radical or Partial Nephrectomy for Renal Masses ≥7 cm Using the RENAL Score</title><author>Kopp, Ryan P ; Liss, Michael A ; Mehrazin, Reza ; Wang, Song ; Lee, Hak J ; Jabaji, Ramzi ; Mirheydar, Hossein S ; Gillis, Kyle ; Patel, Nishant ; Palazzi, Kerrin L ; Wan, Jim Y ; Patterson, Anthony L ; Derweesh, Ithaar H</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c420t-6931d179d0439c126e690d970569a2ab8df86858f3c3733a019910a9d280f2c53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Carcinoma, Renal Cell - pathology</topic><topic>Carcinoma, Renal Cell - surgery</topic><topic>Female</topic><topic>Humans</topic><topic>Kidney - physiology</topic><topic>Kidney Function Tests</topic><topic>Kidney Neoplasms - pathology</topic><topic>Kidney Neoplasms - surgery</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Nephrectomy - methods</topic><topic>Recovery of Function</topic><topic>Retrospective Studies</topic><topic>Tumor Burden</topic><topic>Urology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kopp, Ryan P</creatorcontrib><creatorcontrib>Liss, Michael A</creatorcontrib><creatorcontrib>Mehrazin, Reza</creatorcontrib><creatorcontrib>Wang, Song</creatorcontrib><creatorcontrib>Lee, Hak J</creatorcontrib><creatorcontrib>Jabaji, Ramzi</creatorcontrib><creatorcontrib>Mirheydar, Hossein S</creatorcontrib><creatorcontrib>Gillis, Kyle</creatorcontrib><creatorcontrib>Patel, Nishant</creatorcontrib><creatorcontrib>Palazzi, Kerrin L</creatorcontrib><creatorcontrib>Wan, Jim Y</creatorcontrib><creatorcontrib>Patterson, Anthony L</creatorcontrib><creatorcontrib>Derweesh, Ithaar H</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Urology (Ridgewood, N.J.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kopp, Ryan P</au><au>Liss, Michael A</au><au>Mehrazin, Reza</au><au>Wang, Song</au><au>Lee, Hak J</au><au>Jabaji, Ramzi</au><au>Mirheydar, Hossein S</au><au>Gillis, Kyle</au><au>Patel, Nishant</au><au>Palazzi, Kerrin L</au><au>Wan, Jim Y</au><au>Patterson, Anthony L</au><au>Derweesh, Ithaar H</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Analysis of Renal Functional Outcomes After Radical or Partial Nephrectomy for Renal Masses ≥7 cm Using the RENAL Score</atitle><jtitle>Urology (Ridgewood, N.J.)</jtitle><addtitle>Urology</addtitle><date>2015-08-01</date><risdate>2015</risdate><volume>86</volume><issue>2</issue><spage>312</spage><epage>320</epage><pages>312-320</pages><issn>0090-4295</issn><eissn>1527-9995</eissn><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract><![CDATA[Objective To determine if partial nephrectomy (PN) confers a renal functional benefit compared to radical nephrectomy (RN) for clinical T2 renal masses (T2RM) when adjusting for tumor complexity characterized by the RENAL nephrometry score. Methods A 2-center study of 202 patients with T2RM undergoing RN (122) or PN (80) (median follow-up, 41.5 months). RN and PN cohorts were subanalyzed according to RENAL sum as a categorical variable of <10 or ≥10. Primary outcome was median change in estimated glomerular filtration rate (ΔeGFR) between preoperative to 6 months postoperative. Logistic regression–identified prognostic factors and survival models analyzed association between the RENAL sum and the freedom from de novo chronic kidney disease (CKD; eGFR<60 mL/min/1.73m2 ). Results No significant differences existed between PN and RN for RENAL score. ΔeGFR was greater in RN (−19.7) vs PN (−11.9; P = .006). De novo CKD was 40.2% after RN vs 16.3% after PN ( P <.001). RENAL score ≥10 (odds ratio, 6.67; P = .025) and RN among patients with RENAL score <10 (odds ratio, 24.8; P <.001) were independently associated with de novo CKD at 6 months by logistic regression. Among patients with RENAL score <10, median CKD-free survival was PN 38 vs RN 16 months ( P = .001). Cox proportional hazard demonstrated decreasing risk of CKD for PN vs RN from RENAL 10 (hazard ratio, 0.836) to RENAL 6 (hazard ratio, 0.003; P = .001). Conclusion RN is independently associated with decreased renal function compared to PN for T2RM with RENAL sum ≤10, but not >10, with larger relative decrease in eGFR for each decrease in RENAL sum. Further investigation is required to determine optimal candidates for PN in T2RM.]]></abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>26189330</pmid><doi>10.1016/j.urology.2015.02.067</doi><tpages>9</tpages></addata></record> |
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subjects | Carcinoma, Renal Cell - pathology Carcinoma, Renal Cell - surgery Female Humans Kidney - physiology Kidney Function Tests Kidney Neoplasms - pathology Kidney Neoplasms - surgery Male Middle Aged Nephrectomy - methods Recovery of Function Retrospective Studies Tumor Burden Urology |
title | Analysis of Renal Functional Outcomes After Radical or Partial Nephrectomy for Renal Masses ≥7 cm Using the RENAL Score |
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