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EDITORIAL COMMENT

  • Paul Russo
    Correspondence
    Address correspondence to: Paul Russo M.D., F.A.C.S., Weill Cornell School of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065.
    Affiliations
    Weill Cornell School of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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      The authors retrospectively evaluated 6319 patients with renal tumors from 1980 to 2018 of whom 56% were treated with radical nephrectomy (RN) and 44% with partial nephrectomy (PN). They utilized multivariable linear and competing risk Cox proportional hazards models for increase in chronic kidney disease (CKD) staging to determine if there was a significant interaction between type of operation and preoperative CKD stage. They reported 12 months eGFR calculations in 3046 (48%) of the patients. Of note, 2055 patients (33%) had significant preexisting CKD (eGFR<60), 3466 patients (54%) had hypertension, 843 patients (13%) were diabetic, and 3440 patients (54%) were former or current smokers. In this study, of the 3564 patients undergoing RN, 2469 (70%) had tumors that were T2 or greater (median size 6.8 cm) compared to 133 of 2755 patients (5%, median size 3.0 cm) who underwent PN. Interestingly, 851 patients (13%) had benign disease on final pathology. The authors reported that percent change in eGFR at 1 year was significantly worse for RN compared to PN and RN was significantly more likely to result in CKD stage progression compared with PN for CKD stages 1-3b but not stage 4 (eGFR 14-29).
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