title: Comparison of renal function detriments after local tumor ablation or partial nephrectomy for renal cell carcinoma.
abstract: OBJECTIVE
  Local tumor ablation (LTA) and partial nephrectomy (PN) represent treatment alternatives for patients diagnosed with small renal mass and both may result in renal function detriments. The aim of the study was to compare renal function detriments after LTA or PN.
  
  
  METHODS
  A Surveillance epidemiology and End Results-Medicare-linked retrospective cohort of 2850 T1 kidney cancer patients who underwent LTA or PN was abstracted. Short-term outcomes consisted of 30-day acute kidney injury (AKI) and 30-day dialysis rates. Long-term outcomes consisted of episodes of AKI, mild and moderate-severe chronic kidney disease (CKD), end-stage renal disease, hemodialysis and anemia in CKD. Analyses consisted of propensity score matching, logistic and Cox regression.
  
  
  RESULTS
  After propensity score matching, 1122 patients remained. The 30-day incidence of AKI was 4.6 % after LTA and 9.4 % after PN. In multivariable analyses (MVAs), LTA was associated with a lower AKI rate (OR 0.42; p = 0.001). The 30-day incidence of any dialysis was <2 % after either LTA or PN. In MVA, LTA was not associated with a lower rate of any dialysis (OR 0.43; p = 0.2). At long-term assessment, both the unadjusted and adjusted rates of all six examined end points were not different between LTA and PN (all p > 0.5).
  
  
  CONCLUSIONS
  LTA offers short-term protective effect from AKI. The short-term rates of any dialysis treatment are similar after either LTA or PN. At long-term assessment, LTA and PN renal function detriment rates are not different. Concern for long-term functional outcomes should not be a barrier for PN.
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, 264 Blvd. Rene-Levesque E. Room 228, Montreal, QC, H2X 1P1, Canada. alelarcher@gmail.com.|Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy. alelarcher@gmail.com.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Larcher
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, 264 Blvd. Rene-Levesque E. Room 228, Montreal, QC, H2X 1P1, Canada.|Department of Urology, University of Montreal Health Center, Montreal, Canada.
authors.forename: Malek
authors.initials: M
authors.lastname: Meskawi
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, 264 Blvd. Rene-Levesque E. Room 228, Montreal, QC, H2X 1P1, Canada.|Department of Urology, University of Montreal Health Center, Montreal, Canada.
authors.forename: Roger
authors.initials: R
authors.lastname: Valdivieso
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, 264 Blvd. Rene-Levesque E. Room 228, Montreal, QC, H2X 1P1, Canada.|Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Boehm
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, 264 Blvd. Rene-Levesque E. Room 228, Montreal, QC, H2X 1P1, Canada.|Department of Urology, University of Montreal Health Center, Montreal, Canada.
authors.forename: Vincent
authors.initials: V
authors.lastname: Trudeau
authors.affiliation: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.
authors.forename: Zhe
authors.initials: Z
authors.lastname: Tian
authors.affiliation: Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.|Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: Nicola
authors.initials: N
authors.lastname: Fossati
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, 264 Blvd. Rene-Levesque E. Room 228, Montreal, QC, H2X 1P1, Canada.|Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Dell'Oglio
authors.affiliation: Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Lughezzani
authors.affiliation: Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Nicolò
authors.initials: N
authors.lastname: Buffi
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, 264 Blvd. Rene-Levesque E. Room 228, Montreal, QC, H2X 1P1, Canada.
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, 264 Blvd. Rene-Levesque E. Room 228, Montreal, QC, H2X 1P1, Canada.|Department of Urology, University of Montreal Health Center, Montreal, Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Karakiewicz
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000175:diagnosis / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D014943:Global Health; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D015994:Incidence; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods; D011184:Postoperative Period; D057216:Propensity Score; D012189:Retrospective Studies; D012307:Risk Factors; D018426:SEER Program; D013997:Time Factors; D016896:Treatment Outcome
keywords: Acute kidney injury; Chronic kidney disease; Dialysis; Kidney cancer; Local tumor ablation; Nephron-sparing surgery; Partial nephrectomy; Renal function