Non-neoplastic parenchymal changes in kidney cancer and post-partial nephrectomy recovery of renal function.
OBJECTIVE
To explore the association of non-neoplastic parenchymal changes (nNPC) with patients' health and renal function recovery after partial nephrectomy (PN).


METHODS
This retrospective review identified 800 pT1a patients who underwent PN at Memorial Sloan Kettering Cancer Center from 2007 to 2012. Pathology reports were reviewed for nNPC graded as mild or severe: vascular sclerosis (VS), glomerulosclerosis (GS), and fibrosis/scarring. Correlations between nNPC and known preoperative predictors of renal function [age, sex, African-American race, estimated glomerular filtration rate (eGFR), American Society of Anesthesiologists (ASA) score, body mass index, coronary artery disease, and hypertension (HTN)] were assessed using Spearman's rank correlation (ρ). Multivariable linear regression, adjusted for the described known preoperative risk predictors, was performed to evaluate whether the parenchymal features were able to predict 6-month postoperative eGFR.


RESULTS
In this study, 46 % of tumors had benign surrounding parenchyma. We noted statistically significant yet weak associations of VS with age (ρ = 0.19; p < 0.001), ASA (ρ = 0.09; p < 0.001), preoperative eGFR (ρ = -0.14; p < 0.001), and HTN (ρ = 0.14; p < 0.001). GS also significantly correlated with HTN, but the correlation was again small (ρ = 0.12; p < 0.001). After adjusting for known risk predictors, only GS was a significant predictor of 6-month postoperative eGFR. When compared with no GS, mild and severe GS were negatively associated with a decrease of 4.9 and 10.8 mL/min/1.73 m(2) in 6-month postoperative eGFR, respectively.


CONCLUSIONS
Presence of VS and GS correlated with patients' baseline health, and presence of GS predicted postoperative renal function recovery.
Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
Wassim M
WM
Bazzi
Ling Y
LY
Chen
Billy H
BH
Cordon
Joseph
J
Mashni
Daniel D
DD
Sjoberg
Melanie
M
Bernstein
Paul
P
Russo
D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D007668:Kidney / Q000473:pathology* / Q000503:physiopathology; D007680:Kidney Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D011184:Postoperative Period; D011379:Prognosis; D020127:Recovery of Function / Q000502:physiology*; D051436:Renal Insufficiency, Chronic / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D012189:Retrospective Studies; D013997:Time Factors