Risk Factors of Preoperative Renal Dysfunction and Its Impact on Survival in Patients with Renal Tumor and Inferior Vena Cava Tumor Thrombus.

BACKGROUND

Renal tumor and inferior vena cava tumor thrombus (RT-IVCTT), as a unique model for investigating congestive renal injury, remains largely unexplored. Although chronic kidney disease significantly correlates with postoperative adverse events and long-term prognosis in both renal tumor and pan-cancer settings, there is no large-scale evidence specifically addressing RT-IVCTT. This study aimed to identify risk factors of preoperative renal dysfunction (pre-RD) and evaluate its contribution as a predictor for prognosis in patients with RT-IVCTT.

PATIENTS AND METHODS

Consecutive postoperative patients with RT-IVCTT and no evidence of distant metastasis (n = 208) were retrospectively enrolled between June 2013 and June 2023. Preoperative estimated glomerular filtration rate (pre-eGFR) (mL/min/1.73 m) was classified into four categories: ≥ 120, 90-120, 60-90, and < 60, and clinical data were analyzed to determine a meaningful cutoff. Multivariate logistic and Cox regression models were employed to identify risk factors of pre-RD and prognosis in patients with RT-IVCTT, respectively.

RESULTS

Pre-RD, defined as pre-eGFR < 90 mL/min/1.73 m, was found in 59 patients (28.4%). Pre-RD was associated with increased operative time, intraoperative blood transfusion, extended intensive care unit stay, major complications and long-term survival. Age > 56 years, body mass index > 24 kg/m, left-sided tumors, and IVC obstruction > 75% were independent risk factors for pre-RD. Survival analysis revealed that pre-RD was an independent risk factor for poorer overall survival.

CONCLUSIONS

Pre-RD is an independent risk factor for diminished long-term survival after surgery. Hemodynamic changes from IVC obstruction are associated with pre-RD. eGFR-based renal function assessments may improve perioperative management. Chinese Clinical Trial Registry: ChiCTR2400089649.