title: Oncological and functional outcomes after radical nephrectomy for renal cell carcinoma: a comprehensive analysis of prognostic factors.
abstract: OBJECTIVE
  To investigate mortality rates and to comprehensively analyze prognostic indicators after radical nephrectomy for renal cell carcinoma.
  
  
  METHODS
  Data were collected from 147 patients who underwent potentially curative radical nephrectomy for renal cell carcinoma. The following data were analyzed: tumor pathology, patient demographics and clinical parameters, such as pre- and postoperative estimated glomerular filtration rate, as well as the cause of death. Cause-specific survival rates were calculated including deaths caused by renal cell carcinoma and cardiovascular disease. A Cox proportional hazard model was used for statistical analysis.
  
  
  RESULTS
  A univariate analysis showed that age at surgery (≥70 years), postoperative estimated glomerular filtration rate (<45 mL/min/1.73 m(2)), pathological high T stage, grade and venous invasion were significant poor prognostic indicators. The multivariate analysis provided evidence that pathological venous invasion was a significant poor prognostic indicator, whereas age at surgery (≥70 years), pre- (<65 mL/min/1.73 m(2)) or postoperative (<45 mL/min/1.73 m(2)) estimated glomerular filtration rate and pathological high grade were significant poor prognostic indicators in T1 tumor cases.
  
  
  CONCLUSIONS
  Post-radical nephrectomy renal function insufficiency can lead to a poor prognostic outcome, especially in patients with T1 renal cell carcinoma. Physicians should consider a comprehensive follow up focusing on possible causes of death, including those related to both renal cell carcinoma and cardiovascular disease events after radical nephrectomy.
authors.affiliation: Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan. sejimat@grape.med.tottori-u.ac.jp
authors.forename: Takehiro
authors.initials: T
authors.lastname: Sejima
authors.forename: Hideto
authors.initials: H
authors.lastname: Iwamoto
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Masago
authors.forename: Shuichi
authors.initials: S
authors.lastname: Morizane
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Hinata
authors.forename: Akihisa
authors.initials: A
authors.lastname: Yao
authors.forename: Tadahiro
authors.initials: T
authors.lastname: Isoyama
authors.forename: Motoaki
authors.initials: M
authors.lastname: Saito
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takenaka
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000401:mortality / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000601:surgery*; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D006977:Hypertension, Renal / Q000401:mortality; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009392:Nephrectomy / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality*; D011379:Prognosis; D011507:Proteinuria / Q000401:mortality; D012307:Risk Factors