BACKGROUND: The benefits of cytoreductive nephrectomy (CN) in metastatic renal cell carcinoma (mRCC) should outweigh surgical morbidity. Even when the generally agreed upon selection criteria for CN are met, some patients do poorly after surgery. The objective of this study was to identify preoperative factors that were prognostic of outcome in patients who were being considered for CN. METHODS: The authors conducted a retrospective study to investigate the overall survival (OS) of patients who underwent CN using the OS of patients with mRCC who did not undergo CN as a referent group. Patients who underwent CN were divided into 2 groups based on when their OS diverged from that of nonsurgical patients. Chi-square analysis was used to identify variables that differed between the 2 surgical groups. Multivariate Cox proportional hazards regression was used to analyze those variables for the entire CN cohort. Risk factors were defined as preoperative variables that remained significant on multivariate analysis. The median OS and the overall risk of death were calculated based on the number of risk factors. RESULTS: From 1991 to 2007, 566 patients who were eligible for or received systemic therapy underwent CN, and 110 patients received medical therapy alone. On multivariate analysis, independent preoperative predictors of inferior OS in surgical patients included a lactate dehydrogenase level greater than the upper limit of normal, an albumin level less than the lower limit of normal, symptoms at presentation caused by a metastatic site, liver metastasis, retroperitoneal adenopathy, supradiaphragmatic adenopathy, and clinical tumor classification>or=T3. Inferior OS and an increased risk of death were correlated positively with the number of risk factors. Surgical patients who had >or=4 risk factors did not appear to benefit from CN. CONCLUSIONS: The authors of this report identified 7 preoperative variables that permitted them to identify patients who were unlikely to benefit from CN. Copyright (c) 2010 American Cancer Society.
BACKGROUND: The benefits of cytoreductive nephrectomy (CN) in metastatic renal cell carcinoma (mRCC) should outweigh surgical morbidity. Even when the generally agreed upon selection criteria for CN are met, some patients do poorly after surgery. The objective of this study was to identify preoperative factors that were prognostic of outcome in patients who were being considered for CN. METHODS: The authors conducted a retrospective study to investigate the overall survival (OS) of patients who underwent CN using the OS of patients with mRCC who did not undergo CN as a referent group. Patients who underwent CN were divided into 2 groups based on when their OS diverged from that of nonsurgical patients. Chi-square analysis was used to identify variables that differed between the 2 surgical groups. Multivariate Cox proportional hazards regression was used to analyze those variables for the entire CN cohort. Risk factors were defined as preoperative variables that remained significant on multivariate analysis. The median OS and the overall risk of death were calculated based on the number of risk factors. RESULTS: From 1991 to 2007, 566 patients who were eligible for or received systemic therapy underwent CN, and 110 patients received medical therapy alone. On multivariate analysis, independent preoperative predictors of inferior OS in surgical patients included a lactate dehydrogenase level greater than the upper limit of normal, an albumin level less than the lower limit of normal, symptoms at presentation caused by a metastatic site, liver metastasis, retroperitoneal adenopathy, supradiaphragmatic adenopathy, and clinical tumor classification>or=T3. Inferior OS and an increased risk of death were correlated positively with the number of risk factors. Surgical patients who had >or=4 risk factors did not appear to benefit from CN. CONCLUSIONS: The authors of this report identified 7 preoperative variables that permitted them to identify patients who were unlikely to benefit from CN. Copyright (c) 2010 American Cancer Society.
Authors: Andrew T Lenis; Claire S Burton; Vishnukamal Golla; Aydin Pooli; Izak Faiena; David C Johnson; Amirali Salmasi; Alexandra Drakaki; Kiran Gollapudi; Jeremy Blumberg; Allan J Pantuck; Karim Chamie Journal: Urol Oncol Date: 2019-03-28 Impact factor: 3.498
Authors: Ricardo A Rendon; Anil Kapoor; Rodney Breau; Michael Leveridge; Andrew Feifer; Peter C Black; Alan So Journal: Can Urol Assoc J Date: 2014-05 Impact factor: 1.862
Authors: Lorenzo Marconi; Roderick de Bruijn; Erik van Werkhoven; Christian Beisland; Kate Fife; Axel Heidenreich; Anil Kapoor; Jose Karam; Caroline Kauffmann; Tobias Klatte; Boerje Ljungberg; Surena Matin; Daniel Sjoberg; Michael Staehler; Grant D Stewart; Simon Tanguay; Robert Uzzo; Sarah Welsh; Lori Wood; Chris Wood; Axel Bex Journal: World J Urol Date: 2018-08-01 Impact factor: 4.226
Authors: Javier Puente Vázquez; T Alonso Gordoa; J Moreno; L Poma; E Diaz Rubio; A Gomez; J Blazquez; J L Gonzalez Larriba Journal: Curr Treat Options Oncol Date: 2015-03
Authors: Brandon J Manley; Daniel M Tennenbaum; Emily A Vertosick; James J Hsieh; Daniel D Sjoberg; Melissa Assel; Nicole E Benfante; Seth A Strope; Eric Kim; Jozefina Casuscelli; Maria F Becerra; Jonathan A Coleman; Abraham Ari Hakimi; Paul Russo Journal: Urol Oncol Date: 2016-08-24 Impact factor: 3.498