Acute kidney injury after nephron sparing surgery and microwave ablation: focus on incidence, survival impact and prediction

Abstract

Purpose: To compare acute kidney injury (AKI) incidence between nephron sparing surgery (NSS) and microwave ablation (MWA) for T1a RCC patients, reveal the effect of AKI on survival prognosis, construct AKI nomogram and use Law of Total Probability for survival probability (SP) prediction. Materials and methods: Patients were studied retrospectively after NSS (n ¼ 1267) or MWA (n ¼ 210) from January 1, 2011 to June 30, 2017. Using one to one Propensity Score Matching (PSM), 158 pairs of patients were identified for the cohort study. AKI incidence, risk factors and impact on survival outcomes were analyzed using Chi-square test, logistic and cox regression analysis. AKI risk and SP were predicted by nomogram and Law of Total Probability. The performance of the nomogram was assessed with respect to its discrimination, calibration, and clinical usefulness. Results: AKI occurred more commonly in NSS ( 27.85%) cohort, when compared to MWA (17.72%) cohort (p ¼ 0.032), but treatment modality was not independently predictive of AKI occurrence (odds ratio [OR]: 0.598; 95% confidence interval [CI]: 0.282-1.265; p ¼ 0.178). The 5-yr overall survival (OS) was lower in AKI patients (73.5%) compared with non-AKI patients (94.8%; p < 0.001). AKI was an independent risk factor for all-cause mortality in RCC patients (hazard ratio [HR]: 2.820; 95% confidence interval [CI]: 1.110-7.165; p ¼ 0.029). Predictors for both NSS-and MWA-related AKI included tumor diameter, baseline eGFR and CCI score. RENAL score and tumor blood supply can predict AKI after NSS and MWA, respectively. The AKI normograms demonstrated good discrimination, with AUCs >0.86, excellent calibration and net benefits at the decision curve analysis with probabilities !5%. SP predicted by Law of Total Probability was comparable to actual OS. Conclusion: AKI was an early indicator for poor overall survival in RCC patients. It can be predicted by several oncological parameters. Nomogram and Law of Total Probability can accurately predict AKI risk and SP.

Prognostic Significance of Advanced Age in Patients with T1a Renal Cell Carcinoma Treated by Microwave Ablation: A 16-Year Experience

“…6 It is common knowledge that TA has less impact on renal function relative to PN and activates anti-tumor immunity. 18 However, previous studies did not determine whether the technical advantages of TA could be translated into clinical practice. In the absence of a randomized clinical trial, our findings are viewed as the best evidence from a long follow-up period (almost 16 years).…”

Clinical application status and prospect of the combined anti-tumor strategy of ablation and immunotherapy

“…MWA is another novel tumor ablation technology which developed from biologic thermal effects, which is mainly applied in the treatment of solid tumors in liver ( 40 ), lung ( 41 ), kidney ( 42 ), adrenal gland ( 43 ), spleen ( 44 ), thyroid ( 45 ) and breast ( 46 ). The therapeutic effects of MWA depends on the dipolar molecules (primarily water) to align and realign according to the variable electromagnetic field.…”