Abstract
Purpose
Increasing popularity and improved technical feasibility of partial nephrectomy (PN) has encouraged urologists to treat larger renal masses with nephron-sparing surgery. We used a national database to characterize practice patterns for the surgical management of patients with T2 renal tumors and examined the effect of PN on cancer-specific survival in such patients.
Methods
Between 2001 and 2011, 10,259 patients with primary tumor size >7 cm confined to the kidney (T2) were treated surgically for kidney cancer. PN trends were examined using annual percentage change (APC). Multivariate survival models were developed to identify independent determinants of PN use and cancer-specific survival (CSS) following surgical treatment of kidney cancer.
Results
Overall, 543 patients (5.29 %) were treated with PN versus 9716 (94.71 %) who underwent radical nephrectomy (RN). The use of PN increased progressively between 2001 and 2011 (APC +11.1 %, p < 0.05). Male gender, geographic location, year of diagnosis, and disease stage were independent determinants of increased PN use (all p values <0.05). Cancer-specific mortality was not inferior for patients treated with PN versus RN (HR 0.68, 95 % CI 0.50–0.94). Male gender, younger age, white race, tumor size >10 cm, localized disease, and papillary histology were all associated with improved CSS with PN (all p values <0.05).
Conclusions
PN is increasingly utilized to treat T2 renal masses. Our analysis demonstrates that PN for T2 renal masses has no contraindicated effect on CSS.
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References
Van Poppel H et al (2007) A prospective randomized EORTC intergroup phase 3 study comparing the complications of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol 51(6):1606–1615
Lau WK et al (2000) Matched comparison of radical nephrectomy vs nephron-sparing surgery in patients with unilateral renal cell carcinoma and a normal contralateral kidney. Mayo Clin Proc 75(12):1236–1242
Huang WC et al (2006) Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lancet Oncol 7(9):735–740
Clark AT et al (2008) Preservation of renal function following partial or radical nephrectomy using 24-hour creatinine clearance. Eur Urol 54(1):143–149
Huang WC et al (2009) Partial nephrectomy versus radical nephrectomy in patients with small renal tumors—is there a difference in mortality and cardiovascular outcomes? J Urol 181(1):55–61 (discussion 61–62)
Campbell SC et al (2009) Guideline for management of the clinical T1 renal mass. J Urol 182(4):1271–1279
Ljungberg B et al (2010) EAU guidelines on renal cell carcinoma: the 2010 update. Eur Urol 58(3):398–406
Karellas ME et al (2010) Partial nephrectomy for selected renal cortical tumours of ≥7 cm. BJU Int 106(10):1484–1487
Kopp RP et al (2014) Survival outcomes after radical and partial nephrectomy for clinical T2 renal tumours categorised by RENAL nephrometry score. BJU Int 114(5):708–718
Long CJ et al (2012) Partial nephrectomy for renal masses ≥7 cm: technical, oncological and functional outcomes. BJU Int 109(10):1450–1456
National Cancer Institute. Surveillance Epidemiology and End Results (SEER) Program [cited 10 Oct 2014]. http://seer.cancer.gov/popdata/methods.html
Hankey BF, Ries LA, Edwards BK (1999) The surveillance, epidemiology, and end results program: a national resource. Cancer Epidemiol Biomarkers Prev 8(12):1117–1121
Hollenbeck BK et al (2006) Use of nephrectomy at select medical centers—a case of follow the crowd? J Urol 175(2):670–674
Derose SF et al (2013) Racial differences in estimated GFR decline, ESRD, and mortality in an integrated health system. Am J Kidney Dis 62(2):236–244
Tuttle KR et al (2014) Diabetic kidney disease: a report from an ADA consensus conference. Am J Kidney Dis 64(4):510–533
McKiernan J et al (2002) Natural history of chronic renal insufficiency after partial and radical nephrectomy. Urology 59(6):816–820
Patel HD et al (2014) Race and sex disparities in the treatment of older patients with T1a renal cell carcinoma: a comorbidity-controlled competing-risks model. Urol Oncol 32(5):576–583
Garg T et al (2014) Gender disparities in hematuria evaluation and bladder cancer diagnosis: a population based analysis. J Urol 192(4):1072–1077
Taub DA et al (2004) Impact of surgical volume on mortality and length of stay after nephrectomy. Urology 63(5):862–867
Miller DC et al (2006) Partial nephrectomy for small renal masses: an emerging quality of care concern? J Urol 175(3 Pt 1):853–857 (discussion 858)
Li J et al (2014) Kidney cancer incidence and mortality among American Indians and Alaska Natives in the United States, 1990–2009. Am J Public Health 104(Suppl 3):S396–S403
Steffens S et al (2012) Incidence and long-term prognosis of papillary compared to clear cell renal cell carcinoma—a multicentre study. Eur J Cancer 48(15):2347–2352
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Alanee, S., Nutt, M., Moore, A. et al. Partial nephrectomy for T2 renal masses: contemporary trends and oncologic efficacy. Int Urol Nephrol 47, 945–950 (2015). https://doi.org/10.1007/s11255-015-0975-3
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DOI: https://doi.org/10.1007/s11255-015-0975-3