title: Analysis of Renal Functional Outcomes After Radical or Partial Nephrectomy for Renal Masses ≥7 cm Using the RENAL Score.
abstract: OBJECTIVE
  To determine if partial nephrectomy (PN) confers a renal functional benefit compared to radical nephrectomy (RN) for clinical T2 renal masses (T2RM) when adjusting for tumor complexity characterized by the RENAL nephrometry score.
  
  
  METHODS
  A 2-center study of 202 patients with T2RM undergoing RN (122) or PN (80) (median follow-up, 41.5 months). RN and PN cohorts were subanalyzed according to RENAL sum as a categorical variable of <10 or ≥10. Primary outcome was median change in estimated glomerular filtration rate (ΔeGFR) between preoperative to 6 months postoperative. Logistic regression-identified prognostic factors and survival models analyzed association between the RENAL sum and the freedom from de novo chronic kidney disease (CKD; eGFR<60 mL/min/1.73m(2)).
  
  
  RESULTS
  No significant differences existed between PN and RN for RENAL score. ΔeGFR was greater in RN (-19.7) vs PN (-11.9; P = .006). De novo CKD was 40.2% after RN vs 16.3% after PN (P <.001). RENAL score ≥10 (odds ratio, 6.67; P = .025) and RN among patients with RENAL score <10 (odds ratio, 24.8; P <.001) were independently associated with de novo CKD at 6 months by logistic regression. Among patients with RENAL score <10, median CKD-free survival was PN 38 vs RN 16 months (P = .001). Cox proportional hazard demonstrated decreasing risk of CKD for PN vs RN from RENAL 10 (hazard ratio, 0.836) to RENAL 6 (hazard ratio, 0.003; P = .001).
  
  
  CONCLUSIONS
  RN is independently associated with decreased renal function compared to PN for T2RM with RENAL sum ≤10, but not >10, with larger relative decrease in eGFR for each decrease in RENAL sum. Further investigation is required to determine optimal candidates for PN in T2RM.
authors.affiliation: Department of Urology, Moores Cancer Center, UC San Diego Health System, La Jolla, CA.
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Kopp
authors.affiliation: Department of Urology, Moores Cancer Center, UC San Diego Health System, La Jolla, CA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Liss
authors.affiliation: Department of Urology, University of Tennessee Health Science Center, Memphis, TN.
authors.forename: Reza
authors.initials: R
authors.lastname: Mehrazin
authors.affiliation: Department of Urology, Moores Cancer Center, UC San Diego Health System, La Jolla, CA.
authors.forename: Song
authors.initials: S
authors.lastname: Wang
authors.affiliation: Department of Urology, Moores Cancer Center, UC San Diego Health System, La Jolla, CA.
authors.forename: Hak J
authors.initials: HJ
authors.lastname: Lee
authors.affiliation: Department of Urology, Moores Cancer Center, UC San Diego Health System, La Jolla, CA.
authors.forename: Ramzi
authors.initials: R
authors.lastname: Jabaji
authors.affiliation: Department of Urology, Moores Cancer Center, UC San Diego Health System, La Jolla, CA.
authors.forename: Hossein S
authors.initials: HS
authors.lastname: Mirheydar
authors.affiliation: Department of Urology, Moores Cancer Center, UC San Diego Health System, La Jolla, CA.
authors.forename: Kyle
authors.initials: K
authors.lastname: Gillis
authors.affiliation: Department of Urology, Moores Cancer Center, UC San Diego Health System, La Jolla, CA.
authors.forename: Nishant
authors.initials: N
authors.lastname: Patel
authors.affiliation: Department of Urology, Moores Cancer Center, UC San Diego Health System, La Jolla, CA.
authors.forename: Kerrin L
authors.initials: KL
authors.lastname: Palazzi
authors.affiliation: Department of Urology, University of Tennessee Health Science Center, Memphis, TN.
authors.forename: Jim Y
authors.initials: JY
authors.lastname: Wan
authors.affiliation: Department of Urology, University of Tennessee Health Science Center, Memphis, TN.
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Patterson
authors.affiliation: Department of Urology, Moores Cancer Center, UC San Diego Health System, La Jolla, CA. Electronic address: iderweesh@gmail.com.
authors.forename: Ithaar H
authors.initials: IH
authors.lastname: Derweesh
mesh_terms: D002292:Carcinoma, Renal Cell / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007668:Kidney / Q000502:physiology*; D007677:Kidney Function Tests; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D020127:Recovery of Function; D012189:Retrospective Studies; D047368:Tumor Burden