Patients With Kidney Cancer, Lowered Kidney Function May Benefit From Tissue-Sparing Surgery

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Title: Patients With Kidney Cancer, Lowered Kidney Function May Benefit From Tissue-Sparing Surgery
URL: http://www.pslgroup.com/dg/22DF92.htm
Doctor's Guide
October 1, 2008

WINSTON-SALEM, NC -- October 1, 2008 -- A study of almost 1,500 kidney cancer patients suggests that surgery to spare as much kidney tissue as possible may improve overall survival in patients who also have reduced kidney function at the time their cancer is diagnosed, according to a study in the journal, Mayo Clinic Proceedings.

"In patients who have the combination of kidney cancer and lowered kidney function, doctors should consider tissue-sparing surgery versus complete removal whenever it is technically feasible," said lead author Joseph Pettus, MD, then with Memorial Sloan Kettering Cancer Center, New York, New York, now with Wake Forest University School of Medicine, Winston-Salem, North Carolina. "Currently this option is significantly underused."

The researchers found that among patients having surgery for kidney cancer, those who also had severely impaired kidney function were almost 3 times more likely to die than patients with normal kidney function.

The research was based on the hypothesis that kidney cancer patients with reduced kidney function prior to surgery would have lower survival rates than cancer patients with normal kidney function. The researchers excluded patients whose disease had spread to the lymph nodes or other parts of the body.

They found that median beginning levels of kidney function in all patients decreased during the 10-year study period by about 10%. Compared with those with normal kidney function, patients who began with moderately reduced function were 150% more likely to die from any cause. Those with severely reduced function were almost 3 times (280%) more likely to die.

Dr. Pettus said the findings suggest that obesity and related diseases that affect kidney function may be contributing to the rising death rates from kidney cancer. Overall death rates increased 323% among kidney cancer patients between 1983 and 2002, despite the fact that the disease is being detected earlier.

He said that rising rates of kidney cancer, combined with a decline in kidney function, is almost a "perfect storm" scenario that may explain the decrease in survival, even among patients with early stages of kidney cancer.

"These findings underscore the importance of considering baseline kidney function when devising treatment plans for patients with kidney tumours," said Dr. Pettus. He said the findings raise concerns that surgery may result in more medical harm than benefit to treating the cancer.

"Our data beg the question of whether patients with moderate to severe kidney disease and small tumours might be better managed through tissue-sparing techniques or a 'watchful waiting' approach," he said.

"Completely removing the kidney may result in more harm than good, particularly in elderly patients with small tumours and other medical problems. For these patients, careful surveillance may be a legitimate option with surgery reserved for cases where the tumour increases in size."

SOURCE: Wake Forest University Baptist Medical Center

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