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Renal Functional Outcome of Partial Nephrectomy for Complex R.E.N.A.L. Score Tumors With or Without Neoadjuvant Sunitinib: A Multicenter Analysis
- Source :
- Clinical genitourinary cancer. 16(2)
- Publication Year :
- 2017
-
Abstract
- Background Sunitinib might optimize the feasibility of partial nephrectomy (PN) for complex renal tumors with imperative indications. We compared the renal functional outcomes of patients with complex renal masses who had undergone sunitinib before PN with those of patients who had not required neoadjuvant sunitinib before PN. Patients and Methods We performed a multicenter retrospective analysis of patients with renal cell carcinoma who had undergone PN for a complex renal mass (R.E.N.A.L. nephrometry score, 10-12) and imperative indications from January 2012 to July 2014. Neoadjuvant sunitinib was used in cases for which PN was not considered feasible. The cohort was divided into those patients who had undergone PN without neoadjuvant sunitinib and those who had undergone PN after sunitinib (no-neoadjuvant vs. neoadjuvant). The change in tumor size and R.E.N.A.L. score were assessed. The primary outcome was the change in the estimated glomerular filtration rate (ΔeGFR) from preoperatively to the last postoperative follow-up visit. Results The data from 125 consecutive patients were analyzed (47 neoadjuvant and 78 no-neoadjuvant; median follow-up, 21 months). The neoadjuvant plus PN patients had had a greater median tumor size preoperatively (7.2 vs. 6 cm; P = .045). Sunitinib caused a significant decrease in the median tumor size (from 7.2 to 5.8 cm [19.4%]; P = .012) and R.E.N.A.L. score (from 11 to 9; P = .001). No significant differences were found between the neoadjuvant and no-neoadjuvant groups in the ischemia time ( P = .413) or incidence of complications ( P = .728). The median ΔeGFR was similar (neoadjuvant, 6.4; no-neoadjuvant, 6.1; P = .534). Linear regression analysis for factors associated with an increasing ΔeGFR demonstrated increasing age (estimate, −0.074; P = .009) increasing body mass index (estimate, −0.087; P = .043), and decreasing baseline eGFR (estimate, −0.104; P = .02) as significant factors. Conclusion The use of neoadjuvant sunitinib might facilitate complex PN and result in renal functional outcomes similar to those of patients with a complex renal mass who had not required neoadjuvant sunitinib.
- Subjects :
- Oncology
Male
medicine.medical_specialty
Urology
medicine.medical_treatment
030232 urology & nephrology
Renal function
urologic and male genital diseases
Kidney
Nephrectomy
03 medical and health sciences
0302 clinical medicine
Renal cell carcinoma
Internal medicine
Carcinoma
Sunitinib
Medicine
Humans
Carcinoma, Renal Cell
Neoadjuvant therapy
Aged
Retrospective Studies
Chemotherapy
business.industry
Retrospective cohort study
Middle Aged
medicine.disease
Kidney Neoplasms
Neoadjuvant Therapy
Treatment Outcome
Chemotherapy, Adjuvant
030220 oncology & carcinogenesis
Female
business
medicine.drug
Glomerular Filtration Rate
Subjects
Details
- ISSN :
- 19380682
- Volume :
- 16
- Issue :
- 2
- Database :
- OpenAIRE
- Journal :
- Clinical genitourinary cancer
- Accession number :
- edsair.doi.dedup.....0631eb7bfcde89ae62f9da8d33edf3f8