Assessment of Cancer Control Outcomes in Patients With High-risk Renal Cell Carcinoma Treated With Partial Nephrectomy
| Autor: | Zhe Tian, Malek Meskawi, Nawar Hanna, Paul Perrotte, Markus Graefen, Shahrokh F. Shariat, Marco Bianchi, Jan Schmitges, Pierre I. Karakiewicz, Jens Hansen, Michael Rink, Maxine Sun, Felix K.-H. Chun |
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| Rok vydání: | 2012 |
| Předmět: |
Male
Risk medicine.medical_specialty Urology medicine.medical_treatment Nephrectomy Renal cell carcinoma Carcinoma medicine Humans Stage (cooking) Carcinoma Renal Cell Aged Neoplasm Staging business.industry Mortality rate Hazard ratio Middle Aged medicine.disease Kidney Neoplasms Confidence interval Surgery Treatment Outcome Propensity score matching Female business |
| Zdroj: | Urology. 80:347-353 |
| ISSN: | 0090-4295 |
| DOI: | 10.1016/j.urology.2012.04.043 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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