Nephrectomy improves the survival of patients with locally advanced renal cell carcinoma (original) (raw)
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Journal of Ayub Medical College, Abbottabad : JAMC, 2019
BACKGROUND Radical nephrectomy (RN) is a standard treatment of cure for non-metastatic renal cell carcinoma (NMRCC). Long-term outcome data are limited for Pakistani population. Our aim was to assess the long-term outcomes of RCC treated with curative intent with radical nephrectomy (RN) and to study the 5 & 10years survival outcomes in patients with NMRCC who underwent radical nephrectomy. METHODS This is a retrospective review and analysis of the data between December 2006 and February 2017. We included all the adult patients (age ≥18 years) with NMRCC from both genders irrespective of their histologic subtypes who underwent radical nephrectomy (RN) with a curative intent. The data was analysed for overall survival and recurrence rates at 5- and 10-years using Kaplan-Meier survival analysis. Multivariate analysis was performed using Cox-regression to identify risk factors associated with poor overall outcome in terms of recurrence and mortality. RESULTS Three hundred and forty-fou...
Urologic oncology, 2017
Although partial nephrectomy (PN) is the standard treatment for localized clinical T1a renal cell carcinoma (RCC), treatment of larger renal tumors is controversial. We evaluated the oncological outcomes and perioperative complications after radical and PN for RCC ≥4cm. We retrospectively analyzed the data of 2,373 patients surgically treated for nonmetastatic RCC with clinical T1b or T2 (≥4cm). The propensity scores for surgery type were calculated, and the partial group was matched to the radical group in a 1:3 ratio. The oncological outcomes were compared using Kaplan-Meier analysis and multivariate Cox regression models were used to identify the independent predictors of progression-free, cancer-specific, and overall survival. All differences in preoperative clinical characteristics disappeared after matching. There were no significant differences in progression-free, cancer-specific, or overall survival between the partial and radical groups in the matched cohort. The patients&...
Outcome of Stage T2 or Greater Renal Cell Cancer Treated With Partial Nephrectomy
The Journal of Urology, 2010
Partial nephrectomy for stage T1 renal cell carcinoma is oncologically efficacious and safe, and may have survival advantages. We describe our experience with partial nephrectomy for T2 or greater renal cell cancer. Materials and Methods: Between 1970 and 2008 approximately 2,300 partial nephrectomies were done at our institution, including 69 for sporadic unilateral advanced stage tumors (pT2 in 32, pT3a in 28 and pT3b in 9). We reviewed outcomes in these patients compared to those in 207 treated with radical nephrectomy matched 3:1 for stage, tumor size, baseline renal function, age and gender. Results: The risk of cancer specific (HR 0.80, 95% CI 0.43-1.50, p ϭ 0.489) and overall (HR 1.11, 95% CI 0.72-1.71, p ϭ 0.642) death was similar for partial nephrectomy. At a median of 3.2 years of followup 15 patients (22%) with partial nephrectomy had metastatic disease vs 69 (33%) with radical nephrectomy (HR 0.74, 95% CI 0.42-1.29, p ϭ 0.29). Four patients (6%) with partial nephrectomy had isolated local recurrence vs 7 (3%) with radical nephrectomy (HR 2.11, 95% CI 0.62-7.22, p ϭ 0.234). In the partial nephrectomy group 12 (17%) and 2 cases (3%) were complicated by urine leak and retroperitoneal bleeding requiring intervention, respectively. The median serum creatinine increase was 9.5% (IQR 0-22) vs 33% (IQR 20-47) for partial vs radical nephrectomy (p Ͻ0.001). Conclusions: Partial nephrectomy for T2 or greater renal cell carcinoma preserves renal function and appears to achieve oncological outcomes similar to those of radical nephrectomy. The role of partial nephrectomy in patients with T2-3 tumors and a normal contralateral kidney deserves further consideration and study.
JNCI Cancer Spectrum, 2019
Background. Despite randomized data demonstrating better overall survival favoring radical nephrectomy, partial nephrectomy continues to be the treatment of choice for low-stage renal cell carcinoma. We utilized the National Cancer Database to identify patients younger than 50 years diagnosed with low-stage renal cell carcinoma (cT1) treated with radical nephrectomy or partial nephrectomy (2004)(2005)(2006)(2007). Inverse probability of treatment weighting adjustment was performed for all preoperative factors to account for confounding factors. Kaplan-Meier curves and Cox proportional hazards regression analyses were used to compare overall survival of patients in the two treatment arms. Sensitivity analysis was performed to explore the interaction of type of surgery and clinical stage on overall survival. Results: Among the 3009 patients (median age ¼ 44 years [interquartile range (IQR) ¼ 40-47 years]), 2454 patients (81.6%) were treated with radical nephrectomy and 555 patients (18.4%) with partial nephrectomy. The median follow-up was 108.6 months (IQR ¼ 80.2-124.3 months) during which 297 patients (12.1%) in the radical nephrectomy arm and 58 patients (10.5%) in the partial nephrectomy arm died. Following inverse probability of treatment weighting adjustment, there was no difference in overall survival between patients treated with partial nephrectomy and radical nephrectomy (hazard ratio ¼ 0.83, 95% confidence interval ¼ 0.63 to 1.10, P ¼ .196). There were no statistically significant interactions between type of surgery and clinical stage on treatment outcome. Conclusions: There was no difference in long-term overall survival between radical and partial nephrectomy in young and healthy patients. This patient cohort may have sufficient renal reserve over their lifetime, and preserving nephrons by partial nephrectomy may be unnecessary.
European Urology Supplements, 2011
ERPF. Regression model confirmed that WIT was statistically related to ERPF and this association is evident at 3 months and 1 year postoperatively, even if the model is corrected by every misleading variable. Increasing WIT, ERPF significantly decreases (p<0.0001) such as increasing the average thickness of healthy resected parenchyma (p=0.0023) and this correlation was present 3 months and 1 year after the intervention. Concerning the cutoff for WIT, the median WIT (24 minutes) seem to well define two different Groups of patients (WIT>24' significantly higher risk of ERPF reduction). We divided the patients on the basis of WIT quartile and we identified three categories of risk: group 1 WIT<=15'; group 2 15'28'. The risk of a ERPF reduction was more relevant for group 2 patients with respect to group 1 patients. Similarly, this risk was significantly higher for group3 patient than for group 1 patients. Conclusions: On the basis of our results, the best renal marker of renal damage in patients with a normal contralateral kidney is represented by ERPF evaluated by renal scintigraphy and best predictor for ERPF reduction is WIT. Based on WIT quartiles, we identified three groups of risk for ERPF reduction and we think that this could be helpful for clinical practice.