Impact of Perioperative Infection on Cancer-Specific Survival after Nephrectomy for Renal Cell Carcinoma.

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Impact of Perioperative Infection on Cancer-Specific Survival after Nephrectomy for Renal Cell Carcinoma.

J Urol. 2017 May 24;:

Authors: Tallman JE, Pearce SM, Kuchta K, Helfand BT, Eggener SE

Abstract
INTRODUCTION: Several case reports have documented rare spontaneous cancer regression following systemic infections. Immune-related targeted therapies are now available for many cancers, including renal cell carcinoma (RCC). We hypothesized perioperative infection following nephrectomy for RCC may impact long-term cancer-specific survival (CSS).
METHODS: We performed a retrospective cohort study using Surveillance, Epidemiology, and End Results (SEER)-Medicare claims data from 2004-2011. International Classification of Diseases, 9th Revision (ICD-9) and Current Procedural Terminology (CPT) codes were used to identify patients >65 years old receiving radical or partial nephrectomy for RCC. Patients hospitalized for infection within 30 days of surgery were identified. Exclusion criteria included death within 90 days of surgery, immunodeficiency, and metastatic disease at diagnosis. Kaplan-Meier (KM) curves were used to evaluate CSS between infection vs. no infection groups. Cox proportional hazards model assessed survival controlling for age, sex, race, Elixhauser index, tumor grade, tumor size, histologic subtype, AJCC stage, use of systemic therapy, and geographic region.
RESULTS: Of 8,967 patients, 493 (5.5%) patients were hospitalized for infection after nephrectomy. Median age was 74 years (IQR: 69-79), mean Elixhauser index 4.9 (SD: 7.4) and median follow-up 42 months (IQR: 22-67). Following nephrectomy, univariable Cox regression showed a non-significant improvement in CSS for patients with a serious infection requiring hospitalization (HR 0.84, 95% CI 0.69-1.00, p=0.054). Cox multivariable regression showed a significant improvement in CSS for the same population (HR 0.75, 95% CI: 0.57-0.99, p=0.04). This effect was primarily due to patients with larger (≥ 7 cm) tumors (HR 0.67, 95% CI: 0.44-0.99, p=0.049) with no impact observed among patients with smaller (< 7 cm) tumors (HR 0.82, 95% CI: 0.57-1.19, p=0.3).
CONCLUSIONS: In patients with T2 (≥ 7 cm) RCC undergoing nephrectomy, perioperative infection may improve CSS.

PMID: 28551443 [PubMed - as supplied by publisher]

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