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Cancer control of partial nephrectomy for high-risk localized renal cell carcinoma: population-based and single-institutional analysis

World Journal of Urology volume 33, pages 1807–1814 (2015)Cite this article

Abstract

Purpose

Cancer control of partial nephrectomy for high-risk localized renal cell carcinoma is unclear. To assess whether PN provides adequate cancer control in high-risk disease (HRD), survival outcomes were compared in both a population-based cohort and an institutional cohort.

Methods

Surveillance, Epidemiology, and End Results database and a prospectively maintained institutional database were queried for patients with RCC who underwent PN or RN for a localized tumor ≤7 cm and were found to have high-grade and/or high-stage disease (HRD). Cancer-specific (CSS) or recurrence-free survival (RFS) and overall survival (OS) were primary outcomes measured and were compared between those who underwent PN and RN using multivariable Cox proportional hazards and propensity analysis.

Results

The population cohort consisted of 12,757 (24.9 %) patients with HRD, 85.2 and 14.8 % of which underwent RN and PN, respectively. RN was not associated with CSS (HR 1.23, p = 0.08) but was independently associated with poor OS (HR 1.16, p = 0.031). Propensity analysis showed that RN resulted in a 20 % increased risk of death from all causes (p = 0.008). In the institutional cohort, of 317 patients, 35.9 % had HRD, 56 and 52 of which underwent RN and PN, respectively. Adjusting for age-adjusted Charlson index, RN was a predictor of poor OS (OR 6.20, p = 0.041). Propensity analysis showed that RFS and OS were not related to nephrectomy type (RN HR 0.65, p = 0.627 and RN HR 1.70, p = 0.484).

Conclusions

In patients with pathologic high-risk RCC, partial excision is associated with similar cancer control as compared to radical excision.

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Conflict of interest

The authors declare that they have no conflict of interest.

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The authors have abided by the statement of ethical standards for manuscripts submitted to World Journal of Urology.

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Affiliations

  1. Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA

    Rebecca L. O’Malley, Matthew H. Hayn, Katherine A. Brewer, Willie Underwood III, Hyung L. Kim & Thomas Schwaab

  2. Department of Surgery, Albany Medical College, Urologic Institute of Northeastern New York, 23 Hackett Blvd., MC-208, Albany, NY, 12208, USA

    Rebecca L. O’Malley & Igor Sorokin

  3. Department of Urology, Maine Medical Center, Portland, ME, USA

    Matthew H. Hayn

  4. Division of Urology, Department of Surgery, Bassett Healthcare, Cooperstown, NY, USA

    Nicholas J. Hellenthal

  5. Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Hyung L. Kim

Authors
  1. Rebecca L. O’Malley
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  2. Matthew H. Hayn
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  3. Katherine A. Brewer
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  4. Willie Underwood III
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  5. Nicholas J. Hellenthal
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  6. Hyung L. Kim
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  7. Igor Sorokin
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  8. Thomas Schwaab
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Correspondence to Rebecca L. O’Malley.

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O’Malley, R.L., Hayn, M.H., Brewer, K.A. et al. Cancer control of partial nephrectomy for high-risk localized renal cell carcinoma: population-based and single-institutional analysis. World J Urol 33, 1807–1814 (2015). https://doi.org/10.1007/s00345-015-1538-z

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  • DOI: https://doi.org/10.1007/s00345-015-1538-z

Keywords

  • Renal cell carcinoma
  • Outcomes
  • Nephrectomy
  • Mortality
  • Complications