Parenchymal Volume Replacement by Renal Cell Carcinoma Prior to Intervention: Predictive Factors and Functional Implications
Issued Date
2022-01-01
Resource Type
ISSN
00904295
eISSN
15279995
Scopus ID
2-s2.0-85118338446
Pubmed ID
34606882
Journal Title
Urology
Volume
159
Start Page
139
End Page
145
Rights Holder(s)
SCOPUS
Bibliographic Citation
Urology Vol.159 (2022) , 139-145
Suggested Citation
Palacios D.A. Parenchymal Volume Replacement by Renal Cell Carcinoma Prior to Intervention: Predictive Factors and Functional Implications. Urology Vol.159 (2022) , 139-145. 145. doi:10.1016/j.urology.2021.09.010 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/86738
Title
Parenchymal Volume Replacement by Renal Cell Carcinoma Prior to Intervention: Predictive Factors and Functional Implications
Author(s)
Author's Affiliation
Other Contributor(s)
Abstract
Objective: To analyze predictors, extent and functional implications associated with renal parenchymal volume replacement (PVR) by renal cell carcinoma (RCC) prior to intervention. This phenomenon is well-recognized yet not adequately studied, and, if severe, can influence management. Materials and Methods: A retrospective review was performed of partial nephrectomy (PN) and radical nephrectomy (RN) patients with available preoperative nuclear-renal-scan and imaging demonstrating solitary RCC with normal contralateral kidney. Normal renal parenchymal volume of each kidney was measured by free-hand scripting from preoperative axial images. Primary endpoint was percent PVR which was estimated assuming that the contralateral-kidney serves as a control: PVR = (volume contralateral kidney – volume ipsilateral kidney) normalized by volume contralateral kidney. Multivariable linear-regression analysis assessed factors associated with preoperative PVR. Further analysis evaluated the functional effect of PVR prior to surgery. Results: 146 PN and 136 RN patients with necessary studies were analyzed. For RN, the median PVR was 15% and a quarter of patients had PVR ≥27%. In contrast, PVR was negligible in PN patients for whom median preoperative parenchymal volumes were nearly identical in the ipsilateral/contralateral kidneys (179/180cc, respectively). PVR inversely correlated with preoperative renal function in the ipsilateral kidney (P <.01). Tumor-size (P <.01), stage (P = .03), and endophytic properties (P = .03) associated with PVR on multivariable-analysis. Conclusion: Our data suggest that substantial replacement of normal parenchyma by RCC occurs in many patients selected for RN and can contribute to preexisting renal-insufficiency. PVR prior to intervention is mainly driven by tumor characteristics in RN patients, but is negligible in most PN patients.