Argentina
Argentina
Chronic kidney disease and clear renal cell carcinoma metastasis following radical or partial nephrectomy
Argentina has a long soccer tradition: the Albiceleste, Diego Maradona, La Bombonera, etc (Figure 1). They are certainly a fantastic contender at winning NephroWorldCup as well, this time their team has a very interesting article competing to win the big prize.
Argentinian Nephrology enters The Tournament looking at the incidence of chronic kidney disease (CKD) and metastasis of clear cell carcinoma following partial or radical nephrectomy (Video 1). They strike with a nice retrospective cohort study including patients from 2006 and 2012 who underwent partial or radical nephrectomy; they followed these patients up until 2018. In total they included 32 patients in their cohort (what a coincidence!) 19 radicals and the rest partials.
Those who underwent radical nephrectomy, had more progression of their CKD (63% vs 15% p = 0.007) and were 11 times more likely to progress than those with partial nephrectomies (adjusted HR 11.12; 95% CI: 1.24 - 99.9), none of the patients with stage T1a had metastasis during the follow up period, regardless of the type of surgery. The authors conclude that partial nephrectomy better preserves renal function with a good safety oncologic profile for tumors in stage T1a.
Figure 2. AKI in the Cancer Patient | Presented at Kidney Week 2017 | Image courtesy of Dr. Jyoti Baharani
Figure 1: La Bombonera Stadium
Let's unpack these findings. It is no surprise that Argentina, known by their speed in the field and their world-class strikers (I'm looking at you Messi) will come up with findings that are consistent with previous studies (Figure 2). I think nobody will argue against the fact that partial nephrectomies will preserve better renal function compared to those with radical nephrectomies (Figure 3). This is also important to note, as partial nephrectomies may imply a more complex surgical technique compared to total nephrectomy, training programs must take this into account. Where Argentina has strength they may also want to look at their defense; I mean, look at that confidence interval for their hazard ratios! I can't imagine another team can overcome this statistical significance with a stronger sample size
I applaud Argentina's effort at bringing a strong contender; their strategy is well-known: attack! attack! and attack!
Figure 4. Popularity of Onconephrology conferences on social media compared to other hybrid-nephrology disciplines| 2011-2021 | Data from Dr. Tejas Desai
This team clearly is here to win, but they will meet strong competition. One thing Argentina has in their favor is that this paper combines two specialties: nephrology and oncology. Onconephrology is slowly becoming mainstream, with more people paying attention to the interaction between both disciplines (Figure 4). New therapeutic agents, increased survival, better resection of tumors; make for a compelling argument as the authors went ahead and took a fascinating field and looked at their own data.
Figure 3. Identifying Patients with CKD Risk at the Time of Partial Nephrectomy | Presented at Kidney Week 2021 - PO1852 | By Drs. Kenar Jhaveri, Purva Sharma, Vanessa Bijol, Yihe Yang (zoom in for details
Video 1: Renal Cell Carcinoma and CKD | Courtesy of Drs. Priya Deshpande and Meghana Eswarappa
Argentina has not won a FIFA World Cup in several years. We know this team is thirsty for the biggest title in sports (and nephrology) history! They are here to give a fight and win it all.
Fans of onconephrology are likely to vote for Argentina. How about you?