Renal Functional Outcomes After Nephrectomy in Patients with Localized Renal Cell Carcinoma and Diabetes Mellitus: a Systematic Review and Meta-analysis

Overview

Journal Int Urol Nephrol

Publisher Springer

Specialty Nephrology

Date 2024 Feb 1

PMID 38300449

Authors

Yujia Yang

Linghao Meng

Xu Hu

Xiang Li

Affiliations

Soon will be listed here.

Abstract

Introduction And Objective: Diabetes mellitus (DM), one of the most common comorbidities in patients with renal cell carcinoma (RCC), was proven to be an important prognostic factor of overall survival for these patients. Regarding the influence on renal function after nephrectomy, evidence is still scant. This systematic review and meta-analysis was conducted to provide a more reliable analysis of the association between DM and long-term renal functional outcomes after nephrectomy.

Methods: The PubMed, Web of Science, Embase and Cochrane Library (CENTRAL) databases were searched for eligible studies from inception to January 2023. Hazard ratios (HRs) with 95% confidence intervals (CIs) were extracted to evaluate the association between DM and renal functional outcomes using a random effects model. Stata 17.0 software was used for statistical analysis.

Results: The meta-analysis included thirteen studies consisting of 8562 RCC patients who underwent nephrectomy. Preoperative comorbidity of DM was significantly associated with poor renal functional outcomes (HR = 1.91, 95% CI 1.48-2.48, p < 0.0001), regardless of ethnicity, follow-up time, body mass index (BMI) and age. However, in the radical nephrectomy subgroup, DM was not significantly associated with renal function decline (HR = 1.91, 95% CI 0.93-3.90, p = 0.0781).

Conclusions: The aggregate evidence indicated that preexisting DM may be associated with poor renal functional outcomes in patients with RCC after nephrectomy, especially in patients receiving partial nephrectomy. Urologists should focus more on the glycemic management of these patients after nephrectomy. More high-quality studies are needed to explore the influence of DM on renal function outcomes in postoperative patients.

References

Sung H, Ferlay J, Siegel R, Laversanne M, Soerjomataram I, Jemal A . Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021; 71(3):209-249. DOI: 10.3322/caac.21660. View

Ljungberg B, Albiges L, Abu-Ghanem Y, Bedke J, Capitanio U, Dabestani S . European Association of Urology Guidelines on Renal Cell Carcinoma: The 2022 Update. Eur Urol. 2022; 82(4):399-410. DOI: 10.1016/j.eururo.2022.03.006. View

Rathmell W, Rumble R, Van Veldhuizen P, Al-Ahmadie H, Emamekhoo H, Hauke R . Management of Metastatic Clear Cell Renal Cell Carcinoma: ASCO Guideline. J Clin Oncol. 2022; 40(25):2957-2995. DOI: 10.1200/JCO.22.00868. View

Palacios D, Caraballo E, Tanaka H, Wang Y, Suk-Ouichai C, Ye Y . Compensatory Changes in Parenchymal Mass and Function after Radical Nephrectomy. J Urol. 2020; 204(1):42-49. DOI: 10.1097/JU.0000000000000797. View

Antonelli A, Mari A, Longo N, Novara G, Porpiglia F, Schiavina R . Role of Clinical and Surgical Factors for the Prediction of Immediate, Early and Late Functional Results, and its Relationship with Cardiovascular Outcome after Partial Nephrectomy: Results from the Prospective Multicenter RECORd 1 Project. J Urol. 2017; 199(4):927-932. DOI: 10.1016/j.juro.2017.11.065. View

Bernstein A, Barry E, Fram E, Sankin A, Kovac E, Stern J . Does Glomerular Filtration Rate at Discharge After Partial Nephrectomy Predict Long-Term Glomerular Filtration Rate Stability?. J Endourol. 2019; 33(6):488-491. DOI: 10.1089/end.2018.0869. View

Capitanio U, Larcher A, Fallara G, Trevisani F, Porrini E, Di Marco F . Parenchymal biopsy in the management of patients with renal cancer. World J Urol. 2021; 39(8):2961-2968. DOI: 10.1007/s00345-020-03572-7. View

Bhindi B, Lohse C, Schulte P, Mason R, Cheville J, Boorjian S . Predicting Renal Function Outcomes After Partial and Radical Nephrectomy. Eur Urol. 2018; 75(5):766-772. DOI: 10.1016/j.eururo.2018.11.021. View

Mina-Riascos S, Vitagliano G, Garcia-Perdomo H . Effectiveness and safety of partial nephrectomy-no ischemia vs. warm ischemia: Systematic review and meta-analysis. Investig Clin Urol. 2020; 61(5):464-474. PMC: 7458877. DOI: 10.4111/icu.20190313. View

10.

Deng Y, Li N, Wu Y, Wang M, Yang S, Zheng Y . Global, Regional, and National Burden of Diabetes-Related Chronic Kidney Disease From 1990 to 2019. Front Endocrinol (Lausanne). 2021; 12:672350. PMC: 8281340. DOI: 10.3389/fendo.2021.672350. View

11.

Capitanio U, Larcher A, Terrone C, Antonelli A, Volpe A, Fiori C . End-Stage Renal Disease After Renal Surgery in Patients with Normal Preoperative Kidney Function: Balancing Surgical Strategy and Individual Disorders at Baseline. Eur Urol. 2016; 70(4):558-561. DOI: 10.1016/j.eururo.2016.03.023. View

12.

Tourojman M, Kirmiz S, Boelkins B, Noyes S, Davis A, ODonnell K . Impact of Reduced Glomerular Filtration Rate and Proteinuria on Overall Survival of Patients with Renal Cancer. J Urol. 2015; 195(3):588-93. DOI: 10.1016/j.juro.2015.09.083. View

13.

Demir O, Bozkurt O, Celik S, Comez K, Aslan G, Mungan U . Partial nephrectomy vs. radical nephrectomy for stage I renal cell carcinoma in the presence of predisposing systemic diseases for chronic kidney disease. Kaohsiung J Med Sci. 2017; 33(7):339-343. DOI: 10.1016/j.kjms.2017.05.007. View

14.

Nisen H, Jarvinen P, Kilpelainen T, Jarvinen R, Visapaa H, Taari K . Hand-assisted laparoscopic versus open partial nephrectomy in patients with T1 renal tumor: Comparative perioperative, functional and oncological outcome. Scand J Urol. 2015; 49(6):446-452. DOI: 10.3109/21681805.2015.1076030. View

15.

Beksac A, Reddy B, Martini A, Paulucci D, Moshier E, Abaza R . Hypertension and diabetes mellitus are not associated with worse renal functional outcome after partial nephrectomy in patients with normal baseline kidney function. Int J Urol. 2018; 26(1):120-125. DOI: 10.1111/iju.13819. View

16.

Page M, McKenzie J, Bossuyt P, Boutron I, Hoffmann T, Mulrow C . The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372:n71. PMC: 8005924. DOI: 10.1136/bmj.n71. View

17.

Stang A . Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010; 25(9):603-5. DOI: 10.1007/s10654-010-9491-z. View

18.

Lo C, Mertz D, Loeb M . Newcastle-Ottawa Scale: comparing reviewers' to authors' assessments. BMC Med Res Methodol. 2014; 14:45. PMC: 4021422. DOI: 10.1186/1471-2288-14-45. View

19.

Begg C, Mazumdar M . Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994; 50(4):1088-101. View

20.

Jia Y, Poor S, Dufault B, Lu V, Nayak J, Pruthi D . Chronic kidney damage pathology score for systematic assessment of the non-neoplastic kidney tissue and prediction of post-operative renal function outcomes. Hum Pathol. 2022; 124:76-84. DOI: 10.1016/j.humpath.2022.03.003. View