Tumor size and postoperative kidney function following radical nephrectomy

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 and Jordan, Susan J 2019, Tumor size and postoperative kidney function following radical nephrectomy, Clinical epidemiology, vol. 11, pp. 333-348, doi: 10.2147/CLEP.S197968.

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Title Tumor size and postoperative kidney function following radical nephrectomy
Author(s) Ellis, Robert J
White, Victoria MORCID iD for White, Victoria M orcid.org/0000-0001-6619-8484
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
Journal name Clinical epidemiology
Volume number 11
Start page 333
End page 348
Total pages 16
Publisher DovePress
Place of publication Macclesfield, Eng.
Publication date 2019-05-06
ISSN 1179-1349
Keyword(s) glomerular filtration rate
kidney cancer
living kidney donors
renal cell carcinoma
selection bias
tumor size
Science & Technology
Life Sciences & Biomedicine
Public, Environmental & Occupational Health
Summary 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.
Language eng
DOI 10.2147/CLEP.S197968
Field of Research 1117 Public Health and Health Services
1103 Clinical Sciences
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2019, Ellis et al.
Persistent URL http://hdl.handle.net/10536/DRO/DU:30122840

Document type: Journal Article
Collections: Faculty of Health
School of Psychology
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