Cancer Res Treat.  2016 Apr;48(2):612-620. 10.4143/crt.2014.122.

Oncologic and Functional Outcomes after Partial Nephrectomy Versus Radical Nephrectomy in T1b Renal Cell Carcinoma: A Multicenter, Matched Case-Control Study in Korean Patients

• Jang HA
• Kim JW
• Byun SS
• Hong SH
• Kim YJ
• Park YH
• Yang KS
• Cho S
• Cheon J
• Kang SH

• KMID: 2454339
• DOI: http://doi.org/10.4143/crt.2014.122

Abstract

PURPOSE
The study was to compare the oncologic and functional outcomes of partial nephrectomy (PN) and radical nephrectomy (RN) for pathologically proven T1b renal cell carcinoma using pair-matched groups.
MATERIALS AND METHODS
We reviewed our prospectively maintained database for RN and PN in T1b renal tumors surgically treated between 1999 and 2011 at five institutions in Korea. Of 611 patients treated with PN or RN for a solitary and NX/N0 M0 renal mass (4-7 cm), 577 (PN, 100; RN, 477) patients with pathologically confirmed pT1b remained for analysis. Study subjects were grouped by PN or RN, then matched by age, sex, comorbidities, body mass index, tumor size and depth, histologic type, and preoperative estimated glomerular filtration rate (eGFR) using propensities score. To evaluate oncologic outcomes, overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS) rates were analyzed. The functional outcomes were evaluated by postoperative eGFR.
RESULTS
The median follow-up in the RN group was 48.1 and 42.6 months in the PN group. The estimated 10-year CSS rate (PN 85.7% vs. RN 84.4%, p=0.52) and 5- and estimated 10-year PFS rates (PN: 86.4% and 79.2% vs. RN: 86.0% and 66.1%, p=0.66) did not differ significantly between groups. The estimated 10-year OS rate was significantly higher in the PN group (85.7%) compared to the RN group (73.3%) (p=0.003). PN was less likely to induce new-onset chronic kidney disease (CKD) and end-stage CKD compared with RN.
CONCLUSION
Our study suggests that patients treated with PN demonstrate a superior OS rate and postoperative renal function with analogous CSS and PFS rates compared with pair-matched patients treated with RN.

Keyword

T1b; Renal cell carcinoma; Partial nephrectomy; Nephron-sparing surgery

MeSH Terms

Body Mass Index
Carcinoma, Renal Cell*
Case-Control Studies*
Comorbidity
Disease-Free Survival
Follow-Up Studies
Glomerular Filtration Rate
Humans
Korea
Nephrectomy*
Prospective Studies
Renal Insufficiency, Chronic

Figure

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  Fig. 1. Kaplan-Meier analysis of progression-free survival (A), cancer-specific survival (B), and overall survival (C) for 200 patients after partial nephrectomy (PN) or radical nephrectomy (RN) for T1b renal cell carcinoma. Comparison of survival analysis performed using the log-rank test.

• 

  Fig. 2. Comparison of renal function from baseline to 4-year follow-up. PN, partial nephrectomy; RN, radical nephrectomy; SD, standard deviation.

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  Fig. 3. Kaplan-Meier estimates of new-onset chronic kidney disease (CKD) rate for patients after partial nephrectomy (PN) or radical nephrectomy (RN) for T1b renal cell carcinoma.

Reference

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