Assessment of cancer control outcomes in patients with high-risk renal cell carcinoma treated with partial nephrectomy
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Assessment of cancer control outcomes in patients with high-risk renal cell carcinoma treated with partial nephrectomy. / Hansen, Jens; Sun, Maxine; Bianchi, Marco; Rink, Michael; Tian, Zhe; Hanna, Nawar; Meskawi, Malek; Schmitges, Jan; Shariat, Shahrokh F; Chun, Felix K-H; Perrotte, Paul; Graefen, Markus; Karakiewicz, Pierre I.
in: UROLOGY, Jahrgang 80, Nr. 2, 2, 08.2012, S. 347-353.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Assessment of cancer control outcomes in patients with high-risk renal cell carcinoma treated with partial nephrectomy
AU - Hansen, Jens
AU - Sun, Maxine
AU - Bianchi, Marco
AU - Rink, Michael
AU - Tian, Zhe
AU - Hanna, Nawar
AU - Meskawi, Malek
AU - Schmitges, Jan
AU - Shariat, Shahrokh F
AU - Chun, Felix K-H
AU - Perrotte, Paul
AU - Graefen, Markus
AU - Karakiewicz, Pierre I
N1 - Copyright © 2012 Elsevier Inc. All rights reserved.
PY - 2012/8
Y1 - 2012/8
N2 - OBJECTIVE: To test whether cancer control outcomes justify the consideration of partial nephrectomy in patients with large tumors (Stage pT2 or greater) or high-grade tumors (Fuhrman grade III-IV) or lesions extending beyond the kidney (Stage pT3a).METHODS: We abstracted the data for 8847, 11 547, and 5232 patients with tumors >7 cm, Fuhrman grade III-IV, and Stage T3a from the Surveillance, Epidemiology, and End Results database, respectively. All were treated with either partial nephrectomy or radical nephrectomy from 1988 to 2008. The 2- and 5-year cancer-specific mortality rates were compared between the partial nephrectomy and radical nephrectomy groups after propensity score matching. Separate multivariate analyses were conducted within each subcohort and specifically quantified the effect of partial nephrectomy on cancer-specific mortality.RESULTS: For each of the 3 examined groups, the patients treated with partial nephrectomy failed to demonstrate statistically significant cancer-specific mortality differences relative to radical nephrectomy patients. The hazard ratio for the tumors >7 cm, Fuhrman grade III-IV, and Stage pT3a was 0.67 (95% confidence interval 0.39-1.17, P = .2), 0.81 (95% confidence interval 0.58-1.12, P = .21), and 0.99 (95% confidence interval 0.61-1.61, P = 1.0).CONCLUSION: Even in patients with adverse pathologic features, partial nephrectomy does not compromise cancer-specific mortality. This implies that when functional outcomes are considered in patients with high-risk features, the decision to perform partial nephrectomy should not depend on the stage or grade, but rather on the technical ability to remove the tumor with a negative margin and provide sufficient functional renal remnant.
AB - OBJECTIVE: To test whether cancer control outcomes justify the consideration of partial nephrectomy in patients with large tumors (Stage pT2 or greater) or high-grade tumors (Fuhrman grade III-IV) or lesions extending beyond the kidney (Stage pT3a).METHODS: We abstracted the data for 8847, 11 547, and 5232 patients with tumors >7 cm, Fuhrman grade III-IV, and Stage T3a from the Surveillance, Epidemiology, and End Results database, respectively. All were treated with either partial nephrectomy or radical nephrectomy from 1988 to 2008. The 2- and 5-year cancer-specific mortality rates were compared between the partial nephrectomy and radical nephrectomy groups after propensity score matching. Separate multivariate analyses were conducted within each subcohort and specifically quantified the effect of partial nephrectomy on cancer-specific mortality.RESULTS: For each of the 3 examined groups, the patients treated with partial nephrectomy failed to demonstrate statistically significant cancer-specific mortality differences relative to radical nephrectomy patients. The hazard ratio for the tumors >7 cm, Fuhrman grade III-IV, and Stage pT3a was 0.67 (95% confidence interval 0.39-1.17, P = .2), 0.81 (95% confidence interval 0.58-1.12, P = .21), and 0.99 (95% confidence interval 0.61-1.61, P = 1.0).CONCLUSION: Even in patients with adverse pathologic features, partial nephrectomy does not compromise cancer-specific mortality. This implies that when functional outcomes are considered in patients with high-risk features, the decision to perform partial nephrectomy should not depend on the stage or grade, but rather on the technical ability to remove the tumor with a negative margin and provide sufficient functional renal remnant.
KW - Humans
KW - Male
KW - Aged
KW - Female
KW - Middle Aged
KW - Treatment Outcome
KW - Neoplasm Staging
KW - Risk
KW - Carcinoma, Renal Cell/pathology/surgery
KW - Kidney Neoplasms/pathology/surgery
KW - Nephrectomy/methods
KW - Humans
KW - Male
KW - Aged
KW - Female
KW - Middle Aged
KW - Treatment Outcome
KW - Neoplasm Staging
KW - Risk
KW - Carcinoma, Renal Cell/pathology/surgery
KW - Kidney Neoplasms/pathology/surgery
KW - Nephrectomy/methods
U2 - 10.1016/j.urology.2012.04.043
DO - 10.1016/j.urology.2012.04.043
M3 - SCORING: Journal article
C2 - 22698478
VL - 80
SP - 347
EP - 353
JO - UROLOGY
JF - UROLOGY
SN - 0090-4295
IS - 2
M1 - 2
ER -
