Survival advantage of partial over radical nephrectomy in patients presenting with localized renal cell carcinoma
Partial nephrectomy (PN) preserves renal function and has become the standard approach for T1a renal cell carcinoma (RCC). However, there is still an ongoing debate as to which patients will actually derive greater benefit from partial than from radical nephrectomy (RN). The aim of this study was to...
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| Veröffentlicht in: | BMC cancer 2014-05, Vol.14 (1), p.372-372, Article 372 |
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| creator | Roos, Frederik C Steffens, Sandra Junker, Kerstin Janssen, Martin Becker, Frank Wegener, Gerd Brenner, Walburgis Steinestel, Julie Schnoeller, Thomas J Schrader, Mark Hofmann, Rainer Thüroff, Joachim W Kuczyk, Markus A Wunderlich, Heiko Siemer, Stefan Hartmann, Arndt Stöckle, Michael Schrader, Andres J |
| description | Partial nephrectomy (PN) preserves renal function and has become the standard approach for T1a renal cell carcinoma (RCC). However, there is still an ongoing debate as to which patients will actually derive greater benefit from partial than from radical nephrectomy (RN). The aim of this study was to retrospectively evaluate the impact of the type of surgery on overall survival (OS) in patients with localized RCC.
Renal surgery was performed in 4326 patients with localized RCC (pT ≤ 3a N/M0) at six German tertiary care centers from 1980 to 2010: RN in 2955 cases (68.3%), elective (ePN) in 1108 (25.6%), and imperative partial nephrectomy (iPN) in 263 (6.1%) cases. The median follow-up for all patients was 63 months. Kaplan-Meier and Cox regression analyses were carried out to identify prognosticators for OS.
PN was performed significantly more often than RN in patients presenting with lower tumor stages, higher RCC differentiation, and non-clear cell histology. Accordingly, the calculated 5 (10)-year OS rates were 90.0 (74.6)% for ePN, 83.9 (57.5)% for iPN, and 81.2 (64.7)% for RN (p < 0.001). However, multivariate analysis including age, sex, tumor diameter and differentiation, histological subtype, and the year of surgery showed that ePN compared to RN still qualified as an independent factor for improved OS (HR 0.79, 95% CI 0.66-0.94, p = 0.008).
Even allowing for the weaknesses of this retrospective analysis, our multicenter study indicates that in patients with localized RCC, PN appears to be associated with better OS than RN irrespective of age or tumor size. |
| doi_str_mv | 10.1186/1471-2407-14-372 |
| format | Article |
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Renal surgery was performed in 4326 patients with localized RCC (pT ≤ 3a N/M0) at six German tertiary care centers from 1980 to 2010: RN in 2955 cases (68.3%), elective (ePN) in 1108 (25.6%), and imperative partial nephrectomy (iPN) in 263 (6.1%) cases. The median follow-up for all patients was 63 months. Kaplan-Meier and Cox regression analyses were carried out to identify prognosticators for OS.
PN was performed significantly more often than RN in patients presenting with lower tumor stages, higher RCC differentiation, and non-clear cell histology. Accordingly, the calculated 5 (10)-year OS rates were 90.0 (74.6)% for ePN, 83.9 (57.5)% for iPN, and 81.2 (64.7)% for RN (p < 0.001). However, multivariate analysis including age, sex, tumor diameter and differentiation, histological subtype, and the year of surgery showed that ePN compared to RN still qualified as an independent factor for improved OS (HR 0.79, 95% CI 0.66-0.94, p = 0.008).
Even allowing for the weaknesses of this retrospective analysis, our multicenter study indicates that in patients with localized RCC, PN appears to be associated with better OS than RN irrespective of age or tumor size.</description><identifier>ISSN: 1471-2407</identifier><identifier>EISSN: 1471-2407</identifier><identifier>DOI: 10.1186/1471-2407-14-372</identifier><identifier>PMID: 24885955</identifier><language>eng</language><publisher>England: BioMed Central</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Renal Cell - mortality ; Carcinoma, Renal Cell - pathology ; Carcinoma, Renal Cell - surgery ; Female ; Hospitals ; Humans ; Kidney Neoplasms - mortality ; Kidney Neoplasms - pathology ; Kidney Neoplasms - surgery ; Kidneys ; Male ; Medical prognosis ; Middle Aged ; Mortality ; Multivariate Analysis ; Neoplasm Staging ; Nephrectomy - methods ; SEER Program ; Statistical methods ; Surgery ; Survival analysis ; Treatment Outcome ; Tumors</subject><ispartof>BMC cancer, 2014-05, Vol.14 (1), p.372-372, Article 372</ispartof><rights>2014 Roos et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.</rights><rights>Copyright © 2014 Roos et al.; licensee BioMed Central Ltd. 2014 Roos et al.; licensee BioMed Central Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b484t-fb4fbab40ef71ba695e16346b18c2ac33199694f8893cf57b06adbd16b1bcfcd3</citedby><cites>FETCH-LOGICAL-b484t-fb4fbab40ef71ba695e16346b18c2ac33199694f8893cf57b06adbd16b1bcfcd3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4038042/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4038042/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,315,728,781,785,865,886,27929,27930,53796,53798</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24885955$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Roos, Frederik C</creatorcontrib><creatorcontrib>Steffens, Sandra</creatorcontrib><creatorcontrib>Junker, Kerstin</creatorcontrib><creatorcontrib>Janssen, Martin</creatorcontrib><creatorcontrib>Becker, Frank</creatorcontrib><creatorcontrib>Wegener, Gerd</creatorcontrib><creatorcontrib>Brenner, Walburgis</creatorcontrib><creatorcontrib>Steinestel, Julie</creatorcontrib><creatorcontrib>Schnoeller, Thomas J</creatorcontrib><creatorcontrib>Schrader, Mark</creatorcontrib><creatorcontrib>Hofmann, Rainer</creatorcontrib><creatorcontrib>Thüroff, Joachim W</creatorcontrib><creatorcontrib>Kuczyk, Markus A</creatorcontrib><creatorcontrib>Wunderlich, Heiko</creatorcontrib><creatorcontrib>Siemer, Stefan</creatorcontrib><creatorcontrib>Hartmann, Arndt</creatorcontrib><creatorcontrib>Stöckle, Michael</creatorcontrib><creatorcontrib>Schrader, Andres J</creatorcontrib><creatorcontrib>German Renal Cell Cancer Network</creatorcontrib><creatorcontrib>For the German Renal Cell Cancer Network</creatorcontrib><title>Survival advantage of partial over radical nephrectomy in patients presenting with localized renal cell carcinoma</title><title>BMC cancer</title><addtitle>BMC Cancer</addtitle><description>Partial nephrectomy (PN) preserves renal function and has become the standard approach for T1a renal cell carcinoma (RCC). However, there is still an ongoing debate as to which patients will actually derive greater benefit from partial than from radical nephrectomy (RN). The aim of this study was to retrospectively evaluate the impact of the type of surgery on overall survival (OS) in patients with localized RCC.
Renal surgery was performed in 4326 patients with localized RCC (pT ≤ 3a N/M0) at six German tertiary care centers from 1980 to 2010: RN in 2955 cases (68.3%), elective (ePN) in 1108 (25.6%), and imperative partial nephrectomy (iPN) in 263 (6.1%) cases. The median follow-up for all patients was 63 months. Kaplan-Meier and Cox regression analyses were carried out to identify prognosticators for OS.
PN was performed significantly more often than RN in patients presenting with lower tumor stages, higher RCC differentiation, and non-clear cell histology. Accordingly, the calculated 5 (10)-year OS rates were 90.0 (74.6)% for ePN, 83.9 (57.5)% for iPN, and 81.2 (64.7)% for RN (p < 0.001). However, multivariate analysis including age, sex, tumor diameter and differentiation, histological subtype, and the year of surgery showed that ePN compared to RN still qualified as an independent factor for improved OS (HR 0.79, 95% CI 0.66-0.94, p = 0.008).
Even allowing for the weaknesses of this retrospective analysis, our multicenter study indicates that in patients with localized RCC, PN appears to be associated with better OS than RN irrespective of age or tumor size.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Carcinoma, Renal Cell - mortality</subject><subject>Carcinoma, Renal Cell - pathology</subject><subject>Carcinoma, Renal Cell - surgery</subject><subject>Female</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Kidney Neoplasms - mortality</subject><subject>Kidney Neoplasms - pathology</subject><subject>Kidney Neoplasms - surgery</subject><subject>Kidneys</subject><subject>Male</subject><subject>Medical prognosis</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Multivariate Analysis</subject><subject>Neoplasm Staging</subject><subject>Nephrectomy - methods</subject><subject>SEER Program</subject><subject>Statistical methods</subject><subject>Surgery</subject><subject>Survival analysis</subject><subject>Treatment Outcome</subject><subject>Tumors</subject><issn>1471-2407</issn><issn>1471-2407</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNp1kk1v1DAQhi1ERUvhzglZ4sIl1I6d2LkgoRVfUqUegLM1duxdV4md2klQ-fV42bJqUbnY45lnXo1eD0KvKHlHqWwvKBe0qjkRFeUVE_UTdHZMPb0Xn6LnOV8TQoUk8hk6rbmUTdc0Z-jm25JWv8KAoV8hzLC1ODo8QZp9ScbVJpyg96Y8gp12yZo5jrfYh8LM3oY54ynZXAIftvinn3d4iIX2v2yPkw2lz9ihHJCMD3GEF-jEwZDty7v7HP349PH75kt1efX56-bDZaW55HPlNHcaNCfWCaqh7RpLW8ZbTaWpwTBGu67tuJOyY8Y1QpMWet3TAmjjTM_O0fuD7rTo0famTJhgUFPyI6RbFcGrh5Xgd2obV8UJk4TXRWBzENA-_kfgYcXEUe0tV3vLS6TKjxSVt3djpHiz2Dyr0ee9IxBsXLKiDeOkE6SRBX3zD3odl1Qc_EMJShsuRKHIgTIp5pysO05EidpvxWMzvL5vxbHh7xqw373WtmU</recordid><startdate>20140526</startdate><enddate>20140526</enddate><creator>Roos, Frederik C</creator><creator>Steffens, Sandra</creator><creator>Junker, Kerstin</creator><creator>Janssen, Martin</creator><creator>Becker, Frank</creator><creator>Wegener, Gerd</creator><creator>Brenner, Walburgis</creator><creator>Steinestel, Julie</creator><creator>Schnoeller, Thomas J</creator><creator>Schrader, Mark</creator><creator>Hofmann, Rainer</creator><creator>Thüroff, Joachim W</creator><creator>Kuczyk, Markus A</creator><creator>Wunderlich, Heiko</creator><creator>Siemer, Stefan</creator><creator>Hartmann, Arndt</creator><creator>Stöckle, Michael</creator><creator>Schrader, Andres J</creator><general>BioMed Central</general><general>BioMed Central Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20140526</creationdate><title>Survival advantage of partial over radical nephrectomy in patients presenting with localized renal cell carcinoma</title><author>Roos, Frederik C ; Steffens, Sandra ; Junker, Kerstin ; Janssen, Martin ; Becker, Frank ; Wegener, Gerd ; Brenner, Walburgis ; Steinestel, Julie ; Schnoeller, Thomas J ; Schrader, Mark ; Hofmann, Rainer ; Thüroff, Joachim W ; Kuczyk, Markus A ; Wunderlich, Heiko ; Siemer, Stefan ; Hartmann, Arndt ; Stöckle, Michael ; Schrader, Andres J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b484t-fb4fbab40ef71ba695e16346b18c2ac33199694f8893cf57b06adbd16b1bcfcd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Carcinoma, Renal Cell - mortality</topic><topic>Carcinoma, Renal Cell - pathology</topic><topic>Carcinoma, Renal Cell - surgery</topic><topic>Female</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Kidney Neoplasms - mortality</topic><topic>Kidney Neoplasms - pathology</topic><topic>Kidney Neoplasms - surgery</topic><topic>Kidneys</topic><topic>Male</topic><topic>Medical prognosis</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Multivariate Analysis</topic><topic>Neoplasm Staging</topic><topic>Nephrectomy - methods</topic><topic>SEER Program</topic><topic>Statistical methods</topic><topic>Surgery</topic><topic>Survival analysis</topic><topic>Treatment Outcome</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Roos, Frederik C</creatorcontrib><creatorcontrib>Steffens, Sandra</creatorcontrib><creatorcontrib>Junker, Kerstin</creatorcontrib><creatorcontrib>Janssen, Martin</creatorcontrib><creatorcontrib>Becker, Frank</creatorcontrib><creatorcontrib>Wegener, Gerd</creatorcontrib><creatorcontrib>Brenner, Walburgis</creatorcontrib><creatorcontrib>Steinestel, Julie</creatorcontrib><creatorcontrib>Schnoeller, Thomas J</creatorcontrib><creatorcontrib>Schrader, Mark</creatorcontrib><creatorcontrib>Hofmann, Rainer</creatorcontrib><creatorcontrib>Thüroff, Joachim W</creatorcontrib><creatorcontrib>Kuczyk, Markus A</creatorcontrib><creatorcontrib>Wunderlich, Heiko</creatorcontrib><creatorcontrib>Siemer, Stefan</creatorcontrib><creatorcontrib>Hartmann, Arndt</creatorcontrib><creatorcontrib>Stöckle, Michael</creatorcontrib><creatorcontrib>Schrader, Andres J</creatorcontrib><creatorcontrib>German Renal Cell Cancer Network</creatorcontrib><creatorcontrib>For the German Renal Cell Cancer Network</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Access via ProQuest (Open Access)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMC cancer</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Roos, Frederik C</au><au>Steffens, Sandra</au><au>Junker, Kerstin</au><au>Janssen, Martin</au><au>Becker, Frank</au><au>Wegener, Gerd</au><au>Brenner, Walburgis</au><au>Steinestel, Julie</au><au>Schnoeller, Thomas J</au><au>Schrader, Mark</au><au>Hofmann, Rainer</au><au>Thüroff, Joachim W</au><au>Kuczyk, Markus A</au><au>Wunderlich, Heiko</au><au>Siemer, Stefan</au><au>Hartmann, Arndt</au><au>Stöckle, Michael</au><au>Schrader, Andres J</au><aucorp>German Renal Cell Cancer Network</aucorp><aucorp>For the German Renal Cell Cancer Network</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Survival advantage of partial over radical nephrectomy in patients presenting with localized renal cell carcinoma</atitle><jtitle>BMC cancer</jtitle><addtitle>BMC Cancer</addtitle><date>2014-05-26</date><risdate>2014</risdate><volume>14</volume><issue>1</issue><spage>372</spage><epage>372</epage><pages>372-372</pages><artnum>372</artnum><issn>1471-2407</issn><eissn>1471-2407</eissn><abstract>Partial nephrectomy (PN) preserves renal function and has become the standard approach for T1a renal cell carcinoma (RCC). However, there is still an ongoing debate as to which patients will actually derive greater benefit from partial than from radical nephrectomy (RN). The aim of this study was to retrospectively evaluate the impact of the type of surgery on overall survival (OS) in patients with localized RCC.
Renal surgery was performed in 4326 patients with localized RCC (pT ≤ 3a N/M0) at six German tertiary care centers from 1980 to 2010: RN in 2955 cases (68.3%), elective (ePN) in 1108 (25.6%), and imperative partial nephrectomy (iPN) in 263 (6.1%) cases. The median follow-up for all patients was 63 months. Kaplan-Meier and Cox regression analyses were carried out to identify prognosticators for OS.
PN was performed significantly more often than RN in patients presenting with lower tumor stages, higher RCC differentiation, and non-clear cell histology. Accordingly, the calculated 5 (10)-year OS rates were 90.0 (74.6)% for ePN, 83.9 (57.5)% for iPN, and 81.2 (64.7)% for RN (p < 0.001). However, multivariate analysis including age, sex, tumor diameter and differentiation, histological subtype, and the year of surgery showed that ePN compared to RN still qualified as an independent factor for improved OS (HR 0.79, 95% CI 0.66-0.94, p = 0.008).
Even allowing for the weaknesses of this retrospective analysis, our multicenter study indicates that in patients with localized RCC, PN appears to be associated with better OS than RN irrespective of age or tumor size.</abstract><cop>England</cop><pub>BioMed Central</pub><pmid>24885955</pmid><doi>10.1186/1471-2407-14-372</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Adult Aged Aged, 80 and over Carcinoma, Renal Cell - mortality Carcinoma, Renal Cell - pathology Carcinoma, Renal Cell - surgery Female Hospitals Humans Kidney Neoplasms - mortality Kidney Neoplasms - pathology Kidney Neoplasms - surgery Kidneys Male Medical prognosis Middle Aged Mortality Multivariate Analysis Neoplasm Staging Nephrectomy - methods SEER Program Statistical methods Surgery Survival analysis Treatment Outcome Tumors |
| title | Survival advantage of partial over radical nephrectomy in patients presenting with localized renal cell carcinoma |
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