Impact of age on functional decline following radical nephrectomy: Analysis of the International Marker Consortium for Renal Cancer (INMARC).

Authors

null

Mimi Nguyen

University of California San Diego, Department of Urology, La Jolla, CA

Mimi Nguyen , Arman Walia , Ava Saidian , Luke Wang , Kevin Hakimi , Margaret Meagher , Clara Cerrato , Aastha Shah , Franklin Liu , Sohail Dhanji , Dattatraya H Patil , Yasuhisa Fujii , Ithaar H Derweesh

Organizations

University of California San Diego, Department of Urology, La Jolla, CA, University of California-San Diego, San Diego, CA, UC San Diego, La Jolla, CA, Emory University School of Medicine, Atlanta, GA, Department of Urology, Tokyo Medical and Dental University, Bunkyo-Ku, Japan

Research Funding

No funding received
None.

Background: Radical nephrectomy (RN) is a mainstay of management of localized renal cancer >4 cm. RN is associated with renal functional decline, however impact of age on functional decline is unclear. We investigated impact of age on post RN function, focusing on decline to moderate and severe chronic kidney disease (CKD). Methods: This was a retrospective analysis of patients who underwent RN. Patients were stratified by age (<50, 50-70 and >70 years). Primary outcome was development of denovo CKD-S 3b [estimated glomerular filtration rate (eGFR) <45 mL/min/1.73m2)]. Secondary outcomes included denovo CKD-S 3a (eGFR<60) and denovo CKD-S 4 (eGFR<30). Multivariable logistic regression analysis (MVA) was utilized to identify risk factors for renal functional decline. Linear regression was utilized to identify risk factors for increasing DeGFR. Kaplan-Meier analysis (KMA) was utilized to evaluate functional outcomes for different age groups Results: We analyzed 2436 patients (<50 years, n=513; 50-70 years, n=1344; >70, n=579; median follow-up 31.9 months). On MVA, increasing age was an independent risk factor for CKD-S 3a (HR=3.4-9.4, p<0.001), CKD-S 3b (HR=3.4-7.7, p<0.001), and denovo CKD-S 4 (HR=1.96, p=0.027). On linear-regression analysis, increasing age was significantly correlated with increased delta eGFR (β=-0.212, p<0.001). KMA Comparing <50, 50-70 and >70 demonstrated age-associated declines in 5-year freedom from denovo CKD-S 3a (73.9%; 50-70 53.7%; and >70 37.06%, respectively, p<0.001), denovo CKD-S 3b (92.7%; 71.8%; and 55.5%, p<0.001) and denovo CKD-S 4 (93.7%; 89.8%; and >70 81.2%, p<0.001). Conclusions: Increasing age is a risk factor for progressive and clinically significant renal functional decline after RN. Prioritization for nephron-sparing management may be considered when indicated and oncologically safe and feasible in elderly patients to reduce potential risk of sequelae of functional decline.

Linear regression analysis: delta eGFR.

VariablesB (95% CI)95% C.I.p-value
Constant-7.512-15.62 – 0.5970.069
Age-0.212-0.303 – 0.121<.001
BMI0.1330.025 – 0.2920.099
Tumor Size-0.006-0.267 – 0.2550.965

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Abstract Details

Meeting

2023 ASCO Genitourinary Cancers Symposium

Session Type

Poster Session

Session Title

Poster Session C: Renal Cell Cancer; Adrenal, Penile, Urethral and Testicular Cancers

Track

Renal Cell Cancer,Adrenal Cancer,Penile Cancer,Testicular Cancer,Urethral Cancer

Sub Track

Symptoms, Toxicities, Patient-Reported Outcomes, and Whole-Person Care

Citation

J Clin Oncol 41, 2023 (suppl 6; abstr 664)

DOI

10.1200/JCO.2023.41.6_suppl.664

Abstract #

664

Poster Bd #

G15

Abstract Disclosures

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