Do Statin Medications Impact Renal Functional or Oncologic Outcomes for Robot-Assisted Partial Nephrectomy?

Effect of smoking, hypertension and lifestyle factors on kidney cancer - perspectives for prevention and screening programmes

Renal cell carcinoma (RCC) incidence has doubled over the past few decades. However, death rates have remained stable as the number of incidental renal mass diagnoses peaked. RCC has been recognized as a European health care issue, but to date, no screening programmes have been introduced. Well-known modifiable risk factors for RCC are smoking, obesity and hypertension. A direct association between cigarette consumption and increased RCC incidence and RCC-related death has been reported, but the underlying mechanistic pathways for this association are still unclear. Obesity is associated with an increased risk of RCC, but interestingly, improved survival outcomes have been reported in obese patients, a phenomenon known as the obesity paradox. Data on the association between other modifiable risk factors such as diet, dyslipidaemia and physical activity with RCC incidence are conflicting, and potential mechanisms underlying these associations remain to be elucidated.

Influence of statin use on prognosis of patients with renal cell cancer: a meta-analysis

Background

Statin may confer anticancer efficacy, while the studies evaluating the influence of statin on survival of patients with renal cell cancer (RCC) yielded inconsistent results. A systematic review and meta-analysis was performed to investigate the association between statin use and survival of patients with RCC.

Materials and Methods

Cohort studies were identified by search of PubMed, Embase, and Web of Science databases according to the objective of the meta-analysis. A random-effect model incorporating the possible between-study heterogeneity was used for meta-analysis. Subgroup analyses according to study characteristics were also performed.

Results

Seventeen cohort studies involving 42528 patients with RCC were available for the meta-analysis. Results showed that statin use was associated with a better overall survival (OS, hazard ratio [HR]: 0.73, 95% confidence interval [CI]: 0.65 to 0.84, p < 0.001; I² = 40%), progression progression-free survival (PFS, HR: 0.82, 95% CI: 0.68 to 0.98, p = 0.03; I² = 52%), and cancer-specific survival (CSS, HR: 0.76, 95% CI: 0.59 to 0.99, p = 0.04; I² = 38%). Besides, for the outcome of OS and PFS, subgroup analyses showed similar results in patients with surgical and non-surgical anticancer treatments, and in patients with stage I-III and stage IV RCC (p values for subgroup difference all > 0.05).

Conclusions

Statin use may be associated with improved survival outcomes in patients with RCC. Although prospective clinical studies should be considered to validate these results, these findings suggest that statins may be potential adjuvant therapy for patients with RCC.

Statin use and association with postoperative estimated glomerular filtration rates in patients undergoing robotic-assisted partial nephrectomy

OBJECTIVE

To evaluate the association between preoperative statin use with changes in estimated glomerular filtration rate (eGFR) following robotic-assisted partial nephrectomy (RAPN).

METHODS

389 consecutive patients undergoing RAPN were evaluated. Associations of preoperative statin use with change in eGFR from pre-RAPN to POD1, 1 month, 6 months, and 12 months after RAPN were evaluated using longitudinal mixed-effects regression models with random patient-specific intercepts and slopes while accounting for imbalance of preoperative patient and tumor characteristics between groups with stabilized inverse propensity score weighting. Post-operative eGFR change from baseline was measured as total change, maintaining eGFR within 10% of baseline, and as going from eGFR > 60 ml/min/1.73m2 to < 60 ml/min/1.73m2.

RESULTS

167 (43.0%) of 389 patients were on statin therapy preoperatively. Statin patients were older (66 vs. 58 years old) and had higher rates of comorbidities including diabetes mellitus (31.7% vs. 14.9%) and hypertension (82.6% vs. 45%). Statin patients tended to have lower preoperative eGFR (mean±SD, 71.1±17.6 vs. 77.4±19.4 ml/min/1.73m2). There was no evidence of an association of preoperative statin use with changes in eGFR at any time point following RAPN (P=0.66).

CONCLUSION

Patients on pre-operative statins undergoing RAPN had lower eGFR preoperatively compared to those not taking those medications. There was no evidence of an association between preoperative statin use and change in post-RAPN eGFR in the immediate post-operative period or at 1 year following surgery.

Perioperative Statin Use and Acute Kidney Injury in Patients Undergoing Partial Nephrectomy

BACKGROUND

Statin use is widespread among the general population. Data suggest a potentially beneficial effect of statin therapy on renal function following surgery. The impact of statins on post-partial nephrectomy (PN) renal function is unknown. We hypothesized that perioperative statin use may be associated with reduced rates of acute kidney injury (AKI) in patients undergoing PN.

OBJECTIVES

To evaluate the effect of perioperative statin use on AKI rates in patients undergoing PN.

MATERIALS & METHODS

1,056 patients undergoing PN were identified from a prospectively-maintained institutional renal mass database. Exclusion criteria included lack of preoperative serum creatinine (Cr), concurrent surgeries, and those with baseline Cr <0.4. The binary outcome was AKI, defined using modified Kidney Disease Improving Global Outcomes (KDIGO) criteria. Chi-Square and Cochran-Armitage trend tests were used to evaluate the strength of associations. A multivariate logistic regression model was used to determine predictors of AKI.

RESULTS

Statin use was reported by n = 346 (32.8%) patients at the time of surgery. Univariate analysis demonstrated that statin use was associated with an increased risk of AKI following PN (OR 1.38, CI 1.01-1.88, p = 0.04). On multivariate analysis, statin use was no longer associated with AKI following PN (OR 1.09, CI 0.76-1.56, p = 0.65). Gender, BMI, comorbidity index, hypertension, surgical approach, ischemia temperature/time, and nephrometry "R" score were all independently associated with AKI.

CONCLUSIONS

Perioperative statin use at the time of PN was not associated with rates of post-operative AKI. Prospective studies are needed to elucidate the effects of statins on functional outcomes following PN.

Statin use and kidney cancer survival outcomes: A systematic review and meta-analysis

BACKGROUND

Statin use has been associated with improved survival outcomes in various malignancies. Randomized controlled trials are currently underway evaluating their utility as adjunctive cancer therapies. However, studies evaluating the association between statin use and outcomes in kidney cancer yield conflicting results.

METHODS

We searched MEDLINE and EMBASE to identify studies evaluating the association between statin use and kidney cancer survival outcomes. We evaluated risk of bias with the Newcastle-Ottawa Scale. We pooled hazard ratios for recurrence-free survival, progression-free survival, cancer-specific survival, and overall survival using random-effects models. We evaluated publication bias through Begg's and Egger's tests, and the trim and fill procedure.

RESULTS

We identified 12 studies meeting inclusion criteria and summarized data from 18,105 patients. No study was considered to be at high risk of bias. Statin use was not significantly associated with recurrence-free survival (pooled HR 0.97, 95% CI 0.89-1.06) or progression-free survival (pooled HR 0.92, 95% CI 0.51-1.65); however, statin use was associated with marked improvements in cancer-specific survival (pooled HR 0.67, 95% CI 0.47-0.94) and overall survival (pooled HR 0.74, 95% CI 0.63-0.88). There was no strong evidence of publication bias for any outcome.

CONCLUSIONS

Our results demonstrate that statin use among patients with kidney cancer is associated with significantly improved cancer-specific and overall survival. Further studies are needed to confirm the therapeutic role of statins in kidney cancer.

Emerging technologies to improve techniques and outcomes of robotic partial nephrectomy: striving toward the pentafecta

The technique of robotic partial nephrectomy continues to evolve, but the goals remain the same. Achievement of pentafecta outcomes is difficult to obtain; however, surgeons should continue to strive for this standard of excellence. The future continues to be bright for patients and surgeons alike in continuing to perform robot-assisted partial nephrectomy.