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01-11-2015 | Original Article

Cancer control of partial nephrectomy for high-risk localized renal cell carcinoma: population-based and single-institutional analysis

Authors: Rebecca L. O’Malley, Matthew H. Hayn, Katherine A. Brewer, Willie Underwood III, Nicholas J. Hellenthal, Hyung L. Kim, Igor Sorokin, Thomas Schwaab

Published in: World Journal of Urology | Issue 11/2015

Abstract

Purpose

Cancer control of partial nephrectomy for high-risk localized renal cell carcinoma is unclear. To assess whether PN provides adequate cancer control in high-risk disease (HRD), survival outcomes were compared in both a population-based cohort and an institutional cohort.

Methods

Surveillance, Epidemiology, and End Results database and a prospectively maintained institutional database were queried for patients with RCC who underwent PN or RN for a localized tumor ≤7 cm and were found to have high-grade and/or high-stage disease (HRD). Cancer-specific (CSS) or recurrence-free survival (RFS) and overall survival (OS) were primary outcomes measured and were compared between those who underwent PN and RN using multivariable Cox proportional hazards and propensity analysis.

Results

The population cohort consisted of 12,757 (24.9 %) patients with HRD, 85.2 and 14.8 % of which underwent RN and PN, respectively. RN was not associated with CSS (HR 1.23, p = 0.08) but was independently associated with poor OS (HR 1.16, p = 0.031). Propensity analysis showed that RN resulted in a 20 % increased risk of death from all causes (p = 0.008). In the institutional cohort, of 317 patients, 35.9 % had HRD, 56 and 52 of which underwent RN and PN, respectively. Adjusting for age-adjusted Charlson index, RN was a predictor of poor OS (OR 6.20, p = 0.041). Propensity analysis showed that RFS and OS were not related to nephrectomy type (RN HR 0.65, p = 0.627 and RN HR 1.70, p = 0.484).

Conclusions

In patients with pathologic high-risk RCC, partial excision is associated with similar cancer control as compared to radical excision.

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Title: Cancer control of partial nephrectomy for high-risk localized renal cell carcinoma: population-based and single-institutional analysis
Authors: Rebecca L. O’Malley
Matthew H. Hayn
Katherine A. Brewer
Willie Underwood III
Nicholas J. Hellenthal
Hyung L. Kim
Igor Sorokin
Thomas Schwaab
Publication date: 01-11-2015
Publisher: Springer Berlin Heidelberg
Published in: World Journal of Urology / Issue 11/2015
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-015-1538-z

At a glance: The STEP trials

Springer Medicine

Cancer control of partial nephrectomy for high-risk localized renal cell carcinoma: population-based and single-institutional analysis

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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