Comparative effectiveness for survival and renal function of partial and radical nephrectomy for localized renal tumors: A systematic review and meta-analysis

Simon P. Kim, R. Houston Thompson, Stephen A. Boorjian, Christopher J. Weight, Leona C. Han, Mohammad H Murad, Nathan D. Shippee, Patricia J. Erwin, Brian Costello, George K. Chow, Bradley C. Leibovich

Research output: Contribution to journalArticle

235 Citations (Scopus)

Abstract

Purpose: The relative effectiveness of partial vs radical nephrectomy remains unclear in light of the recent phase 3 European Organization for the Research and Treatment of Cancer trial. We performed a systematic review and meta-analysis of partial vs radical nephrectomy for localized renal tumors, considering all cause and cancer specific mortality, and severe chronic kidney disease. Materials and Methods: Cochrane Central Register of Controlled Trials, MEDLINE®, EMBASE®, Scopus and Web of Science® were searched for sporadic renal tumors that were surgically treated with partial or radical nephrectomy. Generic inverse variance with fixed effects models were used to determine the pooled HR for each outcome. Results: Data from 21, 21 and 9 studies were pooled for all cause and cancer specific mortality, and severe chronic kidney disease, respectively. Overall 31,729 (77%) and 9,281 patients (23%) underwent radical and partial nephrectomy, respectively. According to pooled estimates partial nephrectomy correlated with a 19% risk reduction in all cause mortality (HR 0.81, p <0.0001), a 29% risk reduction in cancer specific mortality (HR 0.71, p = 0.0002) and a 61% risk reduction in severe chronic kidney disease (HR 0.39, p <0.0001). However, the pooled estimate of cancer specific mortality for partial nephrectomy was limited by the lack of robustness in consistent findings on sensitivity and subgroup analyses. Conclusions: Our findings suggest that partial nephrectomy confers a survival advantage and a lower risk of severe chronic kidney disease after surgery for localized renal tumors. However, the results should be evaluated in the context of the low quality of the existing evidence and the significant heterogeneity across studies. Future research should use higher quality evidence to clearly demonstrate that partial nephrectomy confers superior survival and renal function.

Original languageEnglish (US)
Pages (from-to)51-57
Number of pages7
JournalJournal of Urology
Volume188
Issue number1
DOIs
StatePublished - Jul 2012

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Nephrectomy
Meta-Analysis
Kidney
Survival
Chronic Renal Insufficiency
Neoplasms
Risk Reduction Behavior
Mortality
MEDLINE
Organizations
Research

Keywords

  • carcinoma, renal cell
  • kidney
  • mortality
  • nephrectomy
  • renal insufficiency

ASJC Scopus subject areas

  • Urology

Cite this

Comparative effectiveness for survival and renal function of partial and radical nephrectomy for localized renal tumors : A systematic review and meta-analysis. / Kim, Simon P.; Thompson, R. Houston; Boorjian, Stephen A.; Weight, Christopher J.; Han, Leona C.; Murad, Mohammad H; Shippee, Nathan D.; Erwin, Patricia J.; Costello, Brian; Chow, George K.; Leibovich, Bradley C.

In: Journal of Urology, Vol. 188, No. 1, 07.2012, p. 51-57.

Research output: Contribution to journalArticle

Kim, Simon P. ; Thompson, R. Houston ; Boorjian, Stephen A. ; Weight, Christopher J. ; Han, Leona C. ; Murad, Mohammad H ; Shippee, Nathan D. ; Erwin, Patricia J. ; Costello, Brian ; Chow, George K. ; Leibovich, Bradley C. / Comparative effectiveness for survival and renal function of partial and radical nephrectomy for localized renal tumors : A systematic review and meta-analysis. In: Journal of Urology. 2012 ; Vol. 188, No. 1. pp. 51-57.
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AU - Kim, Simon P.

AU - Thompson, R. Houston

AU - Boorjian, Stephen A.

AU - Weight, Christopher J.

AU - Han, Leona C.

AU - Murad, Mohammad H

AU - Shippee, Nathan D.

AU - Erwin, Patricia J.

AU - Costello, Brian

AU - Chow, George K.

AU - Leibovich, Bradley C.

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N2 - Purpose: The relative effectiveness of partial vs radical nephrectomy remains unclear in light of the recent phase 3 European Organization for the Research and Treatment of Cancer trial. We performed a systematic review and meta-analysis of partial vs radical nephrectomy for localized renal tumors, considering all cause and cancer specific mortality, and severe chronic kidney disease. Materials and Methods: Cochrane Central Register of Controlled Trials, MEDLINE®, EMBASE®, Scopus and Web of Science® were searched for sporadic renal tumors that were surgically treated with partial or radical nephrectomy. Generic inverse variance with fixed effects models were used to determine the pooled HR for each outcome. Results: Data from 21, 21 and 9 studies were pooled for all cause and cancer specific mortality, and severe chronic kidney disease, respectively. Overall 31,729 (77%) and 9,281 patients (23%) underwent radical and partial nephrectomy, respectively. According to pooled estimates partial nephrectomy correlated with a 19% risk reduction in all cause mortality (HR 0.81, p <0.0001), a 29% risk reduction in cancer specific mortality (HR 0.71, p = 0.0002) and a 61% risk reduction in severe chronic kidney disease (HR 0.39, p <0.0001). However, the pooled estimate of cancer specific mortality for partial nephrectomy was limited by the lack of robustness in consistent findings on sensitivity and subgroup analyses. Conclusions: Our findings suggest that partial nephrectomy confers a survival advantage and a lower risk of severe chronic kidney disease after surgery for localized renal tumors. However, the results should be evaluated in the context of the low quality of the existing evidence and the significant heterogeneity across studies. Future research should use higher quality evidence to clearly demonstrate that partial nephrectomy confers superior survival and renal function.

AB - Purpose: The relative effectiveness of partial vs radical nephrectomy remains unclear in light of the recent phase 3 European Organization for the Research and Treatment of Cancer trial. We performed a systematic review and meta-analysis of partial vs radical nephrectomy for localized renal tumors, considering all cause and cancer specific mortality, and severe chronic kidney disease. Materials and Methods: Cochrane Central Register of Controlled Trials, MEDLINE®, EMBASE®, Scopus and Web of Science® were searched for sporadic renal tumors that were surgically treated with partial or radical nephrectomy. Generic inverse variance with fixed effects models were used to determine the pooled HR for each outcome. Results: Data from 21, 21 and 9 studies were pooled for all cause and cancer specific mortality, and severe chronic kidney disease, respectively. Overall 31,729 (77%) and 9,281 patients (23%) underwent radical and partial nephrectomy, respectively. According to pooled estimates partial nephrectomy correlated with a 19% risk reduction in all cause mortality (HR 0.81, p <0.0001), a 29% risk reduction in cancer specific mortality (HR 0.71, p = 0.0002) and a 61% risk reduction in severe chronic kidney disease (HR 0.39, p <0.0001). However, the pooled estimate of cancer specific mortality for partial nephrectomy was limited by the lack of robustness in consistent findings on sensitivity and subgroup analyses. Conclusions: Our findings suggest that partial nephrectomy confers a survival advantage and a lower risk of severe chronic kidney disease after surgery for localized renal tumors. However, the results should be evaluated in the context of the low quality of the existing evidence and the significant heterogeneity across studies. Future research should use higher quality evidence to clearly demonstrate that partial nephrectomy confers superior survival and renal function.

KW - carcinoma, renal cell

KW - kidney

KW - mortality

KW - nephrectomy

KW - renal insufficiency

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