Article ; Online: Increased risk of overall and cardiovascular mortality after radical nephrectomy for renal cell carcinoma 2 cm or less.
2011 Volume 186, Issue 4, Page(s) 1247–1253
Abstract: ... cm or less.: Materials and methods: From the SEER (Surveillance, Epidemiology and End Results ... registry we identified 4,216 patients with histologically confirmed renal cell carcinoma 2 cm or less ... renal cell carcinoma 2 cm or less. These findings justify the widespread application of nephron sparing techniques ...
| Abstract | Purpose: We used a large, population based registry to assess whether a difference in overall and cardiovascular survival may exist between radical nephrectomy and partial nephrectomy for renal cell carcinoma 2 cm or less. Materials and methods: From the SEER (Surveillance, Epidemiology and End Results) registry we identified 4,216 patients with histologically confirmed renal cell carcinoma 2 cm or less who were treated with partial or radical nephrectomy. Patient and tumor characteristics were compared between the 2 patient groups. Multivariate logistic regression was done to predict the odds of undergoing radical nephrectomy. Cardiovascular survival and overall survival were compared between the 2 cohorts, adjusting for patient and tumor characteristics. Results: Overall 2,301 patients (55%) underwent partial nephrectomy. Partial nephrectomy use steadily increased during the study period from 27% of all cases in 1998 to 66% in 2007. Patients who underwent partial nephrectomy were an average of 2.5 years younger than those treated with radical nephrectomy (56.4 vs 58.9 years, p <0.001). They were more likely to be white and from the western or northeastern United States. Older age was the only independent predictor of radical nephrectomy (OR 1.02, 95% CI 1.01-1.03). When controlling for patient characteristics and surgery year, radical nephrectomy was associated with worse overall mortality (HR 2.24, 95% CI 1.75-2.84) and cardiovascular mortality (HR 2.53, 95% CI 1.51-4.23). Conclusions: Radical nephrectomy is associated with worse overall and cardiovascular survival compared to partial nephrectomy in patients with localized renal cell carcinoma 2 cm or less. These findings justify the widespread application of nephron sparing techniques to treat localized kidney cancer. |
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| MeSH term(s) | Carcinoma, Renal Cell/pathology ; Carcinoma, Renal Cell/surgery ; Cardiovascular Diseases/mortality ; Disease-Free Survival ; Female ; Humans ; Kidney Neoplasms/pathology ; Kidney Neoplasms/surgery ; Male ; Middle Aged ; Nephrectomy ; Proportional Hazards Models ; Risk Factors ; Survival Rate |
| Language | English |
| Publishing date | 2011-10 |
| Publishing country | United States |
| Document type | Journal Article |
| ZDB-ID | 3176-8 |
| ISSN | 1527-3792 ; 0022-5347 |
| ISSN (online) | 1527-3792 |
| ISSN | 0022-5347 |
| DOI | 10.1016/j.juro.2011.05.054 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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