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Prognostic Factors Influencing Long-Term Survival of Patients Undergoing Nephron-Sparing Surgery for Nonmetastatic Renal-Cell Carcinoma (RCC) with Imperative Indications

  • Urologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

We assessed the effect of T stage, Fuhrman’s grade, multifocality, bilaterality, positive surgical margins, and synchronism of bilateral tumors on cancer-specific survival of patients with nonmetastatic renal-cell carcinoma (RCC) undergoing nephron-sparing surgery for imperative indications.

Methods

We retrospectively analyzed 168 patients who underwent nephron-sparing surgery for imperative RCC indications between 1974 and 2002. A total of 85 patients had bilateral RCCs; in 27 patients, the tumors were multifocal. Multivariate Cox proportional hazards models were fitted to assess the features associated with cancer-specific survival.

Results

The median follow-up was 99 months (range, 2–326 months). Patients were followed until January 2008. A total of 52 patients died of their cancer during follow-up. Multivariate analyses of the total group only revealed Fuhrman’s grade 3 (hazard ratio [HR] 2.94) and bilateral occurrence of RCC (HR 1.82) as independent prognostic factors. In a subgroup analysis of patients with bilateral occurrence of RCC, we observed a tendency toward positive surgical margins (HR 2.89, P = 0.08) being another negative prognostic factor. There was no difference in cancer-specific survival between patients with synchronous and metachronous bilateral RCC presence (HR 1.08).

Conclusions

Fuhrman’s grade 3 and bilateral occurrence of RCC were the only statistically significant prognostic factors for cancer-specific survival in patients undergoing nephron-sparing surgery for imperative indications for nonmetastatic RCC. The presence of sporadic multifocal tumors and the synchronous occurrence of bilateral tumors have no influence on cancer-specific survival, while positive surgical margins may have an impact in the subset of patients with bilateral RCC.

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Authors and Affiliations

  1. Department of Urology, University of Heidelberg, Heidelberg, Germany

    Axel Haferkamp, Martin Kurosch, Gencay Hatiboglu, Jesco Pfitzenmaier, Sascha Pahernik, Nina Wagener & Markus Hohenfellner

  2. Department of Medical Biometry, University of Heidelberg, Heidelberg, Germany

    Maria Pritsch

  3. Department of Pathology, University of Heidelberg, Heidelberg, Germany

    Stephan Macher-Goeppinger

Authors
  1. Axel Haferkamp
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  2. Martin Kurosch
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  3. Maria Pritsch
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Correspondence to Axel Haferkamp.

Additional information

A. Haferkamp and M. Kurosch—contributed equally to this article.

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Haferkamp, A., Kurosch, M., Pritsch, M. et al. Prognostic Factors Influencing Long-Term Survival of Patients Undergoing Nephron-Sparing Surgery for Nonmetastatic Renal-Cell Carcinoma (RCC) with Imperative Indications. Ann Surg Oncol 17, 544–551 (2010). https://doi.org/10.1245/s10434-009-0812-y

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