San Diego, CA USA (UroToday.com) Erik Mayer’s group explored the impact of cytoreductive nephrectomy (CN) on renal function and ae presenting this here. They assessed patients in the Autologous Dendritic Cell Immunotherapy Plus Standard Treatment of Advanced Renal Cell Carcinoma (ADAPT) trial, a vaccine based immunotherapy trial. The objective of the present study was to assess renal function before and after CN in this patient population.
Renal function before and after CN was determined using the National Kidney Foundation Kidney Disease Outcomes Quality Initiative Calculator. A retrospective review of prospective collected data from January 2013 through January 2015 was performed for tumor characteristics, established chronic kidney disease (CKD) risk factors, and demographic information. Univariate and multivariate logistic regression analyses were used to evaluate the impact patient and disease-specific factors on pre-operative renal function.
Of 1007 patient for whom preoperative renal function data were available, 198 (19.7%) had CKD ≥ 3 (GFR < 60ml/min/1.73m2). Age at diagnosis (OR 1.064, 95% CI: 1.042-1.087), LDH above the upper limit of normal (OR 1.851, 95% CI: 1.231-2.781), and advanced tumor stage were independent predictors of postoperative CKD ≥ 3. At the time of surgery, the likelihood of having at least CKD 3 was lower for T1 (OR 0.432, 95% CI: 0.192-0.969) and T2 (OR 0.303, 95% CI: 0.117-0.788) than for T3 tumors. Gender, race, low albumin, symptomatic metastasis, and positive lymph nodes were not significantly associated with CKD ≥ 3.
Post-operative GFR data was only available for 426 patients. The median change after CN was a loss of 21.6ml/min/1.73m2. Of the patients available for analysis, 160 (37.6%) developed CKD ≥ 3 post-CN in the setting of previously normal renal function.
Mr. Mayer concluded that 20% of patients with mRCC in the ADAPT trial have baseline CKD ≥ 3 and nearly 40% with previously normal renal function develop CKD ≥ 3 after CN. Moreover, patients who are older and who have more advanced disease may be at higher risk of significant renal insufficiency after CN. These data can be used to council patients preoperatively regarding their risk of post-CN de novo renal insufficiency.
The full study design for ADAPT can be found at https://clinicaltrials.gov/ct2/show/NCT01582672?term=AGS-003&rank=2.
Presented By: Erik N. Mayer, BS
Reported By: Benjamin T. Ristau, MD, Fox Chase Cancer Center, Philadelphia, PA at the 2016 AUA Annual Meeting - May 6 - 10, 2016 – San Diego, California.
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