Life expectancy in some CKD patients could be improved with nephron-sparing treatment

A nephron-sparing treatment selection for small renal masses based on the nephrometry score may improve life expectancy in patients with mild or moderate chronic kidney disease, a study published in the August 2016 issue of the American Journal of Roentgenology said.

Led by Stella K. Kang, a radiologist with the Department of Radiology at the New York School of Medicine, the study was designed to compare the effectiveness of a treatment algorithm for small renal tumors incorporating the nephrometry score, a renal tumor anatomy scoring system developed by urologists, with the current standard of uniformly recommended partial nephrectomy in patients with mild-to-moderate chronic kidney disease (CKD).

According to the study, in the treatment of small renal tumors, the ideal outcome of both complete oncologic control and preservation of renal function is not presently available. Because partial nephrectomy provides superior oncologic control—sometimes at the expense of renal function loss and increased overall mortality—analysis of how these factors should be weighed may facilitate clearer guidelines for selection among nephron-sparing treatments.

"We provide a framework for incorporating tumor imaging features and renal function into treatment selection, which may help to inform physicians regarding the appropriateness of surgery in patients with CKD," Kang said. "Because renal cell carcinoma most often presents as incidental, small, localized, and often indolent tumors in elderly patients with high rates of CKD and comorbidities, competing nononcologic mortality risks should be carefully considered when counseling patients."

"Particularly in such patients with underlying CKD, our modeling results support the integration of renal tumor anatomic features at cross-sectional imaging into decision making for treatment of small renal masses and may be used to provide a patient-centered framework for selection of optimal candidates for ablative therapy," Kang said.