Radical Versus Partial Nephrectomy for cT1 Renal Cell Carcinoma

Boris Gershman, R. Houston Thompson, Stephen A. Boorjian, Christine M. Lohse, Brian Costello, John Cheville, Bradley Leibovich

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: Nephron-sparing surgery is the preferred surgical management of cT1 renal masses, but observational and randomized data conflict regarding a survival benefit. Objective: To examine the associations of radical nephrectomy (RN) versus partial nephrectomy (PN) with oncologic and nononcologic outcomes. Design, setting, and participants: A total of 2459 adults were treated with RN or PN between 1990 and 2011 for a unilateral, sporadic, cT1, M0 solid renal mass. Intervention: RN or PN. Outcome measurements and statistical analysis: Associations of the type of nephrectomy with oncologic outcomes (local ipsilateral recurrence, distant metastases, and cancer-specific mortality [CSM]) and nononcologic outcomes (other-cause mortality [OCM], all-cause mortality [ACM], ≥10% decrease in estimated glomerular filtration rate [CKD10%], and decrease in estimated glomerular filtration rate to <45 ml/min/1.73 m2 [CKD < 45]) were evaluated using several propensity score (PS) techniques. Results and limitations: After PS adjustment using preoperative features, RN was associated with an increased risk of distant metastases, CSM, ACM, CKD10%, and CKD < 45, but not with OCM. However, there remained imbalance in pathologic features. We therefore repeated these analyses in the subset of 1609 patients with renal cell carcinoma (RCC). After adjusting for both preoperative and pathologic features, there was no significant difference in the development of distant metastases or CSM. Although RN remained associated with an increased risk of CKD10% (hazard ratio [HR] 2.07–2.21; p < 0.001 for each PS technique) and CKD < 45 (HR 2.70–2.99; p < 0.001 for each PS technique), it was not significantly associated with OCM (HR 1.10–1.17; p = 0.08–0.5 for each PS technique) or ACM (HR 1.14–1.15; p = 0.2–0.3 for each PS technique, except HR 1.18; p = 0.03 by inverse probability weights). Limitations include unmeasured confounding. Conclusions: Although RN was associated with an increased risk of chronic kidney disease compared with PN, it was not associated with a statistically significant difference in CSM or ACM among patients with cT1 RCC. Patient summary: This study suggests that partial nephrectomy is not associated with markedly improved survival compared with radical nephrectomy. In this observational study, although radical nephrectomy was associated with an increased risk of chronic kidney disease compared with partial nephrectomy, it was not associated with a statistically significant difference in cancer-specific or all-cause mortality.

Original languageEnglish (US)
JournalEuropean Urology
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Nephrectomy
Renal Cell Carcinoma
Propensity Score
Mortality
Neoplasms
Neoplasm Metastasis
Glomerular Filtration Rate
Chronic Renal Insufficiency
Kidney
Survival
Nephrons
Observational Studies

Keywords

  • Chronic kidney disease
  • Partial nephrectomy
  • Propensity score
  • Radical nephrectomy
  • Survival

ASJC Scopus subject areas

  • Urology

Cite this

Gershman, B., Thompson, R. H., Boorjian, S. A., Lohse, C. M., Costello, B., Cheville, J., & Leibovich, B. (Accepted/In press). Radical Versus Partial Nephrectomy for cT1 Renal Cell Carcinoma. European Urology. https://doi.org/10.1016/j.eururo.2018.08.028

Radical Versus Partial Nephrectomy for cT1 Renal Cell Carcinoma. / Gershman, Boris; Thompson, R. Houston; Boorjian, Stephen A.; Lohse, Christine M.; Costello, Brian; Cheville, John; Leibovich, Bradley.

In: European Urology, 01.01.2018.

Research output: Contribution to journalArticle

Gershman, B, Thompson, RH, Boorjian, SA, Lohse, CM, Costello, B, Cheville, J & Leibovich, B 2018, 'Radical Versus Partial Nephrectomy for cT1 Renal Cell Carcinoma', European Urology. https://doi.org/10.1016/j.eururo.2018.08.028
Gershman, Boris ; Thompson, R. Houston ; Boorjian, Stephen A. ; Lohse, Christine M. ; Costello, Brian ; Cheville, John ; Leibovich, Bradley. / Radical Versus Partial Nephrectomy for cT1 Renal Cell Carcinoma. In: European Urology. 2018.
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title = "Radical Versus Partial Nephrectomy for cT1 Renal Cell Carcinoma",
abstract = "Background: Nephron-sparing surgery is the preferred surgical management of cT1 renal masses, but observational and randomized data conflict regarding a survival benefit. Objective: To examine the associations of radical nephrectomy (RN) versus partial nephrectomy (PN) with oncologic and nononcologic outcomes. Design, setting, and participants: A total of 2459 adults were treated with RN or PN between 1990 and 2011 for a unilateral, sporadic, cT1, M0 solid renal mass. Intervention: RN or PN. Outcome measurements and statistical analysis: Associations of the type of nephrectomy with oncologic outcomes (local ipsilateral recurrence, distant metastases, and cancer-specific mortality [CSM]) and nononcologic outcomes (other-cause mortality [OCM], all-cause mortality [ACM], ≥10{\%} decrease in estimated glomerular filtration rate [CKD10{\%}], and decrease in estimated glomerular filtration rate to <45 ml/min/1.73 m2 [CKD < 45]) were evaluated using several propensity score (PS) techniques. Results and limitations: After PS adjustment using preoperative features, RN was associated with an increased risk of distant metastases, CSM, ACM, CKD10{\%}, and CKD < 45, but not with OCM. However, there remained imbalance in pathologic features. We therefore repeated these analyses in the subset of 1609 patients with renal cell carcinoma (RCC). After adjusting for both preoperative and pathologic features, there was no significant difference in the development of distant metastases or CSM. Although RN remained associated with an increased risk of CKD10{\%} (hazard ratio [HR] 2.07–2.21; p < 0.001 for each PS technique) and CKD < 45 (HR 2.70–2.99; p < 0.001 for each PS technique), it was not significantly associated with OCM (HR 1.10–1.17; p = 0.08–0.5 for each PS technique) or ACM (HR 1.14–1.15; p = 0.2–0.3 for each PS technique, except HR 1.18; p = 0.03 by inverse probability weights). Limitations include unmeasured confounding. Conclusions: Although RN was associated with an increased risk of chronic kidney disease compared with PN, it was not associated with a statistically significant difference in CSM or ACM among patients with cT1 RCC. Patient summary: This study suggests that partial nephrectomy is not associated with markedly improved survival compared with radical nephrectomy. In this observational study, although radical nephrectomy was associated with an increased risk of chronic kidney disease compared with partial nephrectomy, it was not associated with a statistically significant difference in cancer-specific or all-cause mortality.",
keywords = "Chronic kidney disease, Partial nephrectomy, Propensity score, Radical nephrectomy, Survival",
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T1 - Radical Versus Partial Nephrectomy for cT1 Renal Cell Carcinoma

AU - Gershman, Boris

AU - Thompson, R. Houston

AU - Boorjian, Stephen A.

AU - Lohse, Christine M.

AU - Costello, Brian

AU - Cheville, John

AU - Leibovich, Bradley

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Nephron-sparing surgery is the preferred surgical management of cT1 renal masses, but observational and randomized data conflict regarding a survival benefit. Objective: To examine the associations of radical nephrectomy (RN) versus partial nephrectomy (PN) with oncologic and nononcologic outcomes. Design, setting, and participants: A total of 2459 adults were treated with RN or PN between 1990 and 2011 for a unilateral, sporadic, cT1, M0 solid renal mass. Intervention: RN or PN. Outcome measurements and statistical analysis: Associations of the type of nephrectomy with oncologic outcomes (local ipsilateral recurrence, distant metastases, and cancer-specific mortality [CSM]) and nononcologic outcomes (other-cause mortality [OCM], all-cause mortality [ACM], ≥10% decrease in estimated glomerular filtration rate [CKD10%], and decrease in estimated glomerular filtration rate to <45 ml/min/1.73 m2 [CKD < 45]) were evaluated using several propensity score (PS) techniques. Results and limitations: After PS adjustment using preoperative features, RN was associated with an increased risk of distant metastases, CSM, ACM, CKD10%, and CKD < 45, but not with OCM. However, there remained imbalance in pathologic features. We therefore repeated these analyses in the subset of 1609 patients with renal cell carcinoma (RCC). After adjusting for both preoperative and pathologic features, there was no significant difference in the development of distant metastases or CSM. Although RN remained associated with an increased risk of CKD10% (hazard ratio [HR] 2.07–2.21; p < 0.001 for each PS technique) and CKD < 45 (HR 2.70–2.99; p < 0.001 for each PS technique), it was not significantly associated with OCM (HR 1.10–1.17; p = 0.08–0.5 for each PS technique) or ACM (HR 1.14–1.15; p = 0.2–0.3 for each PS technique, except HR 1.18; p = 0.03 by inverse probability weights). Limitations include unmeasured confounding. Conclusions: Although RN was associated with an increased risk of chronic kidney disease compared with PN, it was not associated with a statistically significant difference in CSM or ACM among patients with cT1 RCC. Patient summary: This study suggests that partial nephrectomy is not associated with markedly improved survival compared with radical nephrectomy. In this observational study, although radical nephrectomy was associated with an increased risk of chronic kidney disease compared with partial nephrectomy, it was not associated with a statistically significant difference in cancer-specific or all-cause mortality.

AB - Background: Nephron-sparing surgery is the preferred surgical management of cT1 renal masses, but observational and randomized data conflict regarding a survival benefit. Objective: To examine the associations of radical nephrectomy (RN) versus partial nephrectomy (PN) with oncologic and nononcologic outcomes. Design, setting, and participants: A total of 2459 adults were treated with RN or PN between 1990 and 2011 for a unilateral, sporadic, cT1, M0 solid renal mass. Intervention: RN or PN. Outcome measurements and statistical analysis: Associations of the type of nephrectomy with oncologic outcomes (local ipsilateral recurrence, distant metastases, and cancer-specific mortality [CSM]) and nononcologic outcomes (other-cause mortality [OCM], all-cause mortality [ACM], ≥10% decrease in estimated glomerular filtration rate [CKD10%], and decrease in estimated glomerular filtration rate to <45 ml/min/1.73 m2 [CKD < 45]) were evaluated using several propensity score (PS) techniques. Results and limitations: After PS adjustment using preoperative features, RN was associated with an increased risk of distant metastases, CSM, ACM, CKD10%, and CKD < 45, but not with OCM. However, there remained imbalance in pathologic features. We therefore repeated these analyses in the subset of 1609 patients with renal cell carcinoma (RCC). After adjusting for both preoperative and pathologic features, there was no significant difference in the development of distant metastases or CSM. Although RN remained associated with an increased risk of CKD10% (hazard ratio [HR] 2.07–2.21; p < 0.001 for each PS technique) and CKD < 45 (HR 2.70–2.99; p < 0.001 for each PS technique), it was not significantly associated with OCM (HR 1.10–1.17; p = 0.08–0.5 for each PS technique) or ACM (HR 1.14–1.15; p = 0.2–0.3 for each PS technique, except HR 1.18; p = 0.03 by inverse probability weights). Limitations include unmeasured confounding. Conclusions: Although RN was associated with an increased risk of chronic kidney disease compared with PN, it was not associated with a statistically significant difference in CSM or ACM among patients with cT1 RCC. Patient summary: This study suggests that partial nephrectomy is not associated with markedly improved survival compared with radical nephrectomy. In this observational study, although radical nephrectomy was associated with an increased risk of chronic kidney disease compared with partial nephrectomy, it was not associated with a statistically significant difference in cancer-specific or all-cause mortality.

KW - Chronic kidney disease

KW - Partial nephrectomy

KW - Propensity score

KW - Radical nephrectomy

KW - Survival

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