Mp51-15 Major Cardiovascular Events Following Radical or Partial Nephrectomy Using Target Trial Emulation

You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging/Surveillance II (MP51)1 May 2024MP51-15 MAJOR CARDIOVASCULAR EVENTS FOLLOWING RADICAL OR PARTIAL NEPHRECTOMY USING TARGET TRIAL EMULATION Manav Shah, I-Chun Thomas, Calyani Ganesan, Alan Pao, Maria Montez-Rath, and John Leppert Manav ShahManav Shah , I-Chun ThomasI-Chun Thomas , Calyani GanesanCalyani Ganesan , Alan PaoAlan Pao , Maria Montez-RathMaria Montez-Rath , and John LeppertJohn Leppert View All Author Informationhttps://doi.org/10.1097/01.JU.0001009492.49624.4b.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Reduced kidney function is associated with cardiovascular (CV) events and mortality. In patients undergoing kidney cancer surgery, partial nephrectomy preserves more kidney function than radical nephrectomy after surgery, but it remains unknown whether a nephron sparing approach is associated with a reduced risk of CV events. METHODS: We used national data from the Veterans Health Administration (VHA) to emulate a randomized trial of adult patients with a new diagnosis of T1a kidney cancer undergoing either radical nephrectomy (RN) or partial nephrectomy (PN) between January 1, 2010 and December 31, 2017. We excluded patients with an eGFR<30 in the 3 months before surgery. Follow-up began once participants were assigned to their respective treatment strategy and ended with one of the following: 1) the first major adverse cardiovascular event (MACE); 2) after 60 months from the date of surgery; 3) after 12 months from the last VHA interaction; or 4) the last date of data collection (December 31, 2018). We defined MACE as the following: myocardial infarction, stroke, inpatient arrhythmia, inpatient heart failure, and all-cause mortality. In an intention-to-treat analysis, we estimated the unadjusted incidence rate ratio (IRR) and 95% confidence interval (CI) of radical versus partial nephrectomy. RESULTS: We identified 5,074 patients, with 39.0% (n=1977) patients receiving RN and 61.0% (n=3097) patients receiving PN. For the RN group, the mean age was 63.9 years at the time of cancer diagnosis and 64.1 years at the time of surgery; for the PN group, the mean age was 61.7 years at the time of cancer diagnosis and 61.8 years at the time of surgery. The incidence rate of MACE was 12.5 after RN and 9.3 events per 100 person-years after PN. The unadjusted IRR was 1.34 (1.21, 1.48) when comparing incidence rates of MACE for RN and PN. CONCLUSIONS: Radical nephrectomy is associated with a higher incidence of major adverse cardiovascular events in the first 5 years following surgery for early-stage kidney cancer. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e848 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Manav Shah More articles by this author I-Chun Thomas More articles by this author Calyani Ganesan More articles by this author Alan Pao More articles by this author Maria Montez-Rath More articles by this author John Leppert More articles by this author Expand All Advertisement PDF downloadLoading ...