TY - JOUR
T1 - Radical nephrectomy for pT1a renal masses may be associated with decreased overall survival compared with partial nephrectomy
AU - Thompson, R. Houston
AU - Boorjian, Stephen A.
AU - Lohse, Christine M.
AU - Leibovich, Bradley C.
AU - Kwon, Eugene D.
AU - Cheville, John C.
AU - Blute, Michael L.
N1 - Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2008/2
Y1 - 2008/2
N2 - Purpose; We reviewed our surgical experience with small renal tumors, comparing overall survival in patients treated with radical and partial nephrectomy. Materials and Methods; Using our nephrectomy registry we identified patients with sporadic, unilateral, solitary and localized renal masses 4 cm or less who underwent radical or partial nephrectomy between 1989 and 2003. Patients with a solitary kidney or impaired renal function at presentation were excluded, leaving 648 available for analysis. Overall survival was estimated using the Kaplan-Meier method and associations with death were evaluated using Cox proportional hazards regression. Results; At last followup 146 patients had died of any cause and 502 were alive at a median of 7.1 years. Radical and partial nephrectomy was performed in 290 and 358 patients, respectively. In all patients radical nephrectomy was not significantly associated with death from any cause compared with partial nephrectomy (RR 1.12, p = 0.52). However, there was a significant interaction with age, leading us to stratify our analysis at the median age of 65 years. In 327 patients younger than 65 years radical nephrectomy was significantly associated with death from any cause compared with partial nephrectomy (RR 2.16, p = 0.02). The increased risk of death persisted after adjusting for year of surgery (p = 0.02), preoperative creatinine (p = 0.03), Charlson-Romano index (p = 0.04), symptoms at presentation (p = 0.02), diabetes at presentation (p = 0.03) and histology (p = 0.02). Conclusions; Our results suggest that, compared with partial nephrectomy, radical nephrectomy is associated with decreased overall survival in younger patients with small renal masses. Copyriget
AB - Purpose; We reviewed our surgical experience with small renal tumors, comparing overall survival in patients treated with radical and partial nephrectomy. Materials and Methods; Using our nephrectomy registry we identified patients with sporadic, unilateral, solitary and localized renal masses 4 cm or less who underwent radical or partial nephrectomy between 1989 and 2003. Patients with a solitary kidney or impaired renal function at presentation were excluded, leaving 648 available for analysis. Overall survival was estimated using the Kaplan-Meier method and associations with death were evaluated using Cox proportional hazards regression. Results; At last followup 146 patients had died of any cause and 502 were alive at a median of 7.1 years. Radical and partial nephrectomy was performed in 290 and 358 patients, respectively. In all patients radical nephrectomy was not significantly associated with death from any cause compared with partial nephrectomy (RR 1.12, p = 0.52). However, there was a significant interaction with age, leading us to stratify our analysis at the median age of 65 years. In 327 patients younger than 65 years radical nephrectomy was significantly associated with death from any cause compared with partial nephrectomy (RR 2.16, p = 0.02). The increased risk of death persisted after adjusting for year of surgery (p = 0.02), preoperative creatinine (p = 0.03), Charlson-Romano index (p = 0.04), symptoms at presentation (p = 0.02), diabetes at presentation (p = 0.03) and histology (p = 0.02). Conclusions; Our results suggest that, compared with partial nephrectomy, radical nephrectomy is associated with decreased overall survival in younger patients with small renal masses. Copyriget
KW - Carcinoma, renal cell
KW - Kidney
KW - Kidney neoplasms
KW - Mortality
KW - Nephrectomy
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U2 - 10.1016/j.juro.2007.09.077
DO - 10.1016/j.juro.2007.09.077
M3 - Article
C2 - 18076931
AN - SCOPUS:38849201264
SN - 0022-5347
VL - 179
SP - 468
EP - 473
JO - Journal of Urology
JF - Journal of Urology
IS - 2
ER -