Preoperative estimated glomerular filtration rate predicts overall mortality in patients undergoing radical prostatectomy

• Published in: Urologic oncology 2013-11, Vol.31 (8), p.1483-1488
• Main Authors: Tollefson, Matthew K., M.D, Boorjian, Stephen A., M.D, Gettman, Matthew T., M.D, Rangel, Laureano J., M.S, Bergstralh, Eric J., M.S, Karnes, R. Jeffrey, M.D
• Format: Article
• Language: English
• Subjects: Aged; Body Mass Index; Follow-Up Studies; Glomerular Filtration Rate; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Multivariate Analysis; Neoplasm Grading; Neoplasm Staging; Outcome Assessment (Health Care) - methods; Outcome Assessment (Health Care) - statistics & numerical data; Preoperative Period; Prognosis; Proportional Hazards Models; Prostate-Specific Antigen - blood; Prostatectomy - methods; Prostatic Neoplasms - diagnosis; Prostatic Neoplasms - mortality; Prostatic Neoplasms - surgery; Survival Rate; Urology
• ISSN: 1078-1439; 1873-2496
• DOI: 10.1016/j.urolonc.2012.03.014

Abstract Background Assessment of overall health is a critical component in the evaluation of patients presenting with clinically localized prostate cancer. Estimated glomerular filtration rate (eGFR) has been associated with increased risk of cardiovascular and overall mortality. Therefore, the objective of our study was to evaluate the impact of baseline renal function on oncologic outcomes and overall survival following radical prostatectomy. Materials and methods We identified 10,099 patients who underwent radical prostatectomy at our institution from 1990 to 2004 with a preoperative serum creatinine available for analysis. eGFR was calculated by the chronic kidney disease-epidemiology formula (CKD-EPI) and reported as ml/min per 1.73 m2 . Patients were then classified according to their eGFR: 0.05 for all). However, eGFR was strongly associated with all-cause mortality and non-prostate cancer death. On multivariate analysis, after controlling for age, BMI, prostate-specific antigen doubling time (PSA), Gleason score, and clinical stage, eGFR remains a statistically significant predictor of all-cause mortality. Conclusions Assessment of eGFR is an important metric in the overall evaluation of patient health and should be considered in combination with patient age and other medical comorbidities when selecting the initial treatment of prostate cancer. While prostate cancer-specific outcomes do not appear to be impacted by renal function, overall survival is decreased in those with lower and higher than normal eGFR.