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Title: Tumor size and postoperative kidney function following radical nephrectomy.
Austin Authors: Ellis, Robert J;White, Victoria M;Bolton, Damien M ;Coory, Michael D;Davis, Ian D;Francis, Ross S;Giles, Graham G;Gobe, Glenda C;Neale, Rachel E;Wood, Simon T;Jordan, Susan J
Affiliation: Department of Urology, Princess Alexandra Hospital, Brisbane, QLD, Australia
Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
Eastern Health Clinical School, Monash University and Eastern Health, Melbourne, Victoria, Australia
Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, QLD, Australia
Cancer Council Victoria, Melbourne, Victoria, Australia
School of Psychology, Deakin University, Melbourne, Victoria, Australia
Department of Urology, Austin Health, Heidelberg, Victoria, Australia
Issue Date: 6-May-2019
Date: 2019
Publication information: Clinical epidemiology 2019; 11: 333-348
Abstract: Background: Chronic kidney disease (CKD) following nephrectomy for kidney tumors is common, and both patient and tumor characteristics may affect postoperative kidney function. Several studies have reported that surgery for large tumors is associated with a lower likelihood of postoperative CKD, but others have reported CKD to be more common before surgery in patients with large tumors. Objective: The aim of this study was to clarify inconsistencies in the literature regarding the prognostic significance of tumor size for postoperative kidney function. Study design and setting: We analyzed data from 944 kidney cancer patients managed with radical nephrectomy between January 2012 and December 2013, and 242 living kidney donors who underwent surgery between January 2011 and December 2014 in the Australian states of Queensland and Victoria. Multivariable logistic regression was used to assess the primary outcome of CKD upstaging. Structural equation modeling was used to evaluate causal models, to delineate the influence of patient and tumor characteristics on postoperative kidney function. Results: We determined that a significant interaction between age and tumor size (P=0.03) led to the observed inverse association between large tumor size and CKD upstaging, and was accentuated by other forms of selection bias. Subgrouping patients by age and tumor size demonstrated that all patients aged ≥65 years were at increased risk of CKD upstaging, regardless of tumor size. Risk of CKD upstaging was comparable between age-matched living donors and kidney cancer patients. Conclusion: Larger tumors are unlikely to confer a protective effect with respect to postoperative kidney function. The reason for the previously reported inconsistency is likely a combination of the analytical approach and selection bias.
DOI: 10.2147/CLEP.S197968
ORCID: 0000-0002-5145-6783
Journal: Clinical epidemiology
PubMed URL: 31191028
ISSN: 1179-1349
Type: Journal Article
Subjects: glomerular filtration rate
kidney cancer
living kidney donors
renal cell carcinoma
selection bias
tumor size
Appears in Collections:Journal articles

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