Article ; Online: Renal Functional Outcome of Partial Nephrectomy for Complex R.E.N.A.L. Score Tumors With or Without Neoadjuvant Sunitinib: A Multicenter Analysis.
2017 Volume 16, Issue 2, Page(s) e289–e295
Abstract: ... of patients with renal cell carcinoma who had undergone PN for a complex renal mass (R.E.N.A.L. nephrometry ... neoadjuvant). The change in tumor size and R.E.N.A.L. score were assessed. The primary outcome was the change ... 2 to 5.8 cm [19.4%]; P = .012) and R.E.N.A.L. score (from 11 to 9; P = .001). No significant ...
| 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. |
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| MeSH term(s) | Aged ; Carcinoma, Renal Cell/drug therapy ; Carcinoma, Renal Cell/physiopathology ; Carcinoma, Renal Cell/surgery ; Chemotherapy, Adjuvant ; Female ; Glomerular Filtration Rate/drug effects ; Humans ; Kidney/drug effects ; Kidney/pathology ; Kidney/physiopathology ; Kidney Neoplasms/drug therapy ; Kidney Neoplasms/physiopathology ; Kidney Neoplasms/surgery ; Male ; Middle Aged ; Neoadjuvant Therapy ; Nephrectomy/methods ; Retrospective Studies ; Sunitinib/pharmacology ; Sunitinib/therapeutic use ; Treatment Outcome |
| Chemical Substances | Sunitinib (V99T50803M) |
| Language | English |
| Publishing date | 2017-09-25 |
| Publishing country | United States |
| Document type | Comparative Study ; Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't |
| ZDB-ID | 2225121-2 |
| ISSN | 1938-0682 ; 1558-7673 |
| ISSN (online) | 1938-0682 |
| ISSN | 1558-7673 |
| DOI | 10.1016/j.clgc.2017.09.007 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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