Comparison of renal functional outcomes of active surveillance and partial nephrectomy in the management of oncocytoma

Abstract

Purpose

To compare functional outcomes of partial nephrectomy (PN) and active surveillance (AS) in oncocytoma.

Methods

Multicenter retrospective analysis of patients with oncocytoma managed with PN or AS (biopsy-confirmed). Primary outcome development of de novo chronic kidney disease (CKD) (eGFR < 60 mL/min/1.73m2). Cox regression Multivariable analysis (MVA) was carried out for predictors of de novo CKD. Linear regression was carried out for factors associated with increasing deltaGFR. Kaplan–Meier Analysis (KMA) was performed to analyze 5-year CKD-free survival.

Results

295 patients were analyzed (224 PN/71 AS, median follow-up 37.4 months). No differences were noted for clinical tumor size (AS 2.6 vs. PN 2.9 cm, p = 0.108), and baseline eGFR (AS 79.6 vs. PN 77, p = 0.9670). Median change in tumor diameter for AS was 0.42 cm. Compared to PN, AS had deltaGFR (−15.3 vs. −6.4 mL/min/1.73m2, p < 0.001) and de novo CKD (28.2% vs. 12.1%, p = 0.002). AS patients who developed CKD had higher RENAL score (p = 0.005) and lower baseline eGFR (73 vs. 91.2 mL/min/1.73m2, p < 0.001) than AS patients who did not. MVA demonstrated increasing age (OR = 1.03, p = 0.025), tumor size (HR = 1.26, p = 0.032) and AS (HR = 4.91, p < 0.001) to be predictive for de novo CKD. Linear regression demonstrated AS was associated with larger decrease in deltaGFR (B = −0.219, p < 0.001). KMA revealed 5-year CKD survival was higher in PN (87%) vs. AS (62%, p < 0.001).

Conclusion

AS was associated with greater functional decline than PN in oncocytoma. PN may be considered to optimalize renal functional preservation in select circumstances. Further investigation into mechanisms of functional decline in oncocytoma is requisite.

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Funding

The project was supported by Stephen Weissman Kidney Cancer Research Fund.

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Authors

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M: data collection, data analysis, manuscript writing/editing. L: project development, manuscript writing/editing. Capitanio project development, manuscript writing/editing. M: protocol development, data collection, manuscript writing/editing. B: data collection, data management. N: data collection, data management. L: data management, manuscript editing. E: data management, manuscript editing. G: data management, data analysis. P: data management, protocol development. B: data collection, data management. D: data collection, data management. K: data collection, data management. M: data collection, data management. W: data collection, data management, protocol development. M: project development, manuscript writing/editing. D: project development, manuscript writing/editing.

Corresponding author

Correspondence to Ithaar H. Derweesh.

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Meagher, M.F., Lane, B.R., Capitanio, U. et al. Comparison of renal functional outcomes of active surveillance and partial nephrectomy in the management of oncocytoma. World J Urol (2020). https://doi.org/10.1007/s00345-020-03299-5

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Keywords

  • Active surveillance
  • Chronic kidney disease
  • Glomerular filtration rate
  • Kidney neoplasm
  • Oncocytoma
  • Partial nephrectomy