Cancer control of partial nephrectomy for high-risk localized renal cell carcinoma: population-based and single-institutional analysis.
World journal of urology
Carcinoma, Renal Cell, Disease-Free Survival, Female, Follow-Up Studies, Humans, Kidney Neoplasms, Male, Middle Aged, Neoplasm Staging, Nephrectomy, New York, Population Surveillance, Postoperative Complications, Prognosis, Propensity Score, Retrospective Studies, Risk Factors, SEER Program, Survival Rate, Time Factors
PURPOSE: Cancer control of partial nephrectomy for high-risk localized renal cell carcinoma is unclear. To assess whether PN provides adequate cancer control in high-risk disease (HRD), survival outcomes were compared in both a population-based cohort and an institutional cohort.
METHODS: Surveillance, Epidemiology, and End Results database and a prospectively maintained institutional database were queried for patients with RCC who underwent PN or RN for a localized tumor ≤7 cm and were found to have high-grade and/or high-stage disease (HRD). Cancer-specific (CSS) or recurrence-free survival (RFS) and overall survival (OS) were primary outcomes measured and were compared between those who underwent PN and RN using multivariable Cox proportional hazards and propensity analysis.
RESULTS: The population cohort consisted of 12,757 (24.9 %) patients with HRD, 85.2 and 14.8 % of which underwent RN and PN, respectively. RN was not associated with CSS (HR 1.23, p = 0.08) but was independently associated with poor OS (HR 1.16, p = 0.031). Propensity analysis showed that RN resulted in a 20 % increased risk of death from all causes (p = 0.008). In the institutional cohort, of 317 patients, 35.9 % had HRD, 56 and 52 of which underwent RN and PN, respectively. Adjusting for age-adjusted Charlson index, RN was a predictor of poor OS (OR 6.20, p = 0.041). Propensity analysis showed that RFS and OS were not related to nephrectomy type (RN HR 0.65, p = 0.627 and RN HR 1.70, p = 0.484).
CONCLUSIONS: In patients with pathologic high-risk RCC, partial excision is associated with similar cancer control as compared to radical excision.
O'Malley, Rebecca L; Hayn, Matthew H; Brewer, Katherine A; Underwood, Willie; Hellenthal, Nicholas J; Kim, Hyung L; Sorokin, Igor; and Schwaab, Thomas, "Cancer control of partial nephrectomy for high-risk localized renal cell carcinoma: population-based and single-institutional analysis." (2015). Maine Medical Center. 453.