Elsevier

Urology

Volume 80, Issue 2, August 2012, Pages 347-353
Urology

Oncology
Assessment of Cancer Control Outcomes in Patients With High-risk Renal Cell Carcinoma Treated With Partial Nephrectomy

https://doi.org/10.1016/j.urology.2012.04.043Get rights and content

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.

Section snippets

Data Source

The study cohort consisted of patients diagnosed with RCC (C67.0-C67.9) from the Surveillance, Epidemiology, and End Results (SEER) database reported by the National Cancer Institute statistics program, from 1988 to 2008. The SEER routinely collects patient demographics and publishes cancer incidence and survival data from population-based cancer registries covering approximately 26% of the U.S. population.

Study Population

The data from patients with a primary diagnosis of nonmetastatic clear cell, chromophobe,

Results

Overall, 8847, 11 547, and 5232 patients had tumors >7 cm, high-grade RCC, and pT3a lesions, respectively. The results are illustrated for each of the 3 separate subcohorts.

Comment

Several studies have confirmed the equivalence of cancer control outcomes between PN and RN in patients with Stage T1a and T1b RCC.5, 6, 7, 8, 9, 10 Additionally, multiple reports have confirmed the superiority of renal function preservation and overall survival when PN is performed instead of RN.2, 3, 4, 13, 22, 23, 24, 25 Based on these facts, contemporary guidelines have suggested PN for patients with Stage pT1a and some select patients with pT1b lesions, when renal function preservation is

Conclusions

Even in patients with adverse pathologic features, PN does not compromise oncologic outcomes, such as CSM. This implies that when functional considerations require PN in patients with high-risk features, the decision to perform PN should not depend on stage or grade, but rather on the technical ability to remove the tumor with a negative margin and provide sufficient functional renal remnant.

References (26)

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    Funnel plot reporting OS was used to visually inspect the potential for publication bias. Thirteen studies meeting the inclusion criteria were included in the final analysis [8–10,13–16,24–29]. Of these studies, 2 separate analyses for 2 endpoints of the same population of patients were reported by the same group [26,29].

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Financial Disclosure: The authors declare that they have no relevant financial interests.

Financial Support: P. I. Karakiewicz is partially supported by the University of Montréal Health Centre Urology Specialists, Fonds de la Recherche en Sante du Quebec, University of Montréal Department of Surgery, and University of Montréal Health Centre Foundation.

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