Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

ACC 2024 Congress

Catch up on all the top stories and latest evidence in cardiology research with our ACC 2024 Congress hub page.
ADVANCED SEARCH
Log in
Top
BMC Cancer
Published in: BMC Cancer 1/2014

Open Access 01-12-2014 | Research article

Survival advantage of partial over radical nephrectomy in patients presenting with localized renal cell carcinoma

Authors: Frederik C Roos, Sandra Steffens, Kerstin Junker, Martin Janssen, Frank Becker, Gerd Wegener, Walburgis Brenner, Julie Steinestel, Thomas J Schnoeller, Mark Schrader, Rainer Hofmann, Joachim W Thüroff, Markus A Kuczyk, Heiko Wunderlich, Stefan Siemer, Arndt Hartmann, Michael Stöckle, Andres J Schrader, For the German Renal Cell Cancer Network

Published in: BMC Cancer | Issue 1/2014

Login to get access

Abstract

Background

Partial nephrectomy (PN) preserves renal function and has become the standard approach for T1a renal cell carcinoma (RCC). However, there is still an ongoing debate as to which patients will actually derive greater benefit from partial than from radical nephrectomy (RN). The aim of this study was to retrospectively evaluate the impact of the type of surgery on overall survival (OS) in patients with localized RCC.

Methods

Renal surgery was performed in 4326 patients with localized RCC (pT ≤ 3a N/M0) at six German tertiary care centers from 1980 to 2010: RN in 2955 cases (68.3%), elective (ePN) in 1108 (25.6%), and imperative partial nephrectomy (iPN) in 263 (6.1%) cases. The median follow-up for all patients was 63 months. Kaplan-Meier and Cox regression analyses were carried out to identify prognosticators for OS.

Results

PN was performed significantly more often than RN in patients presenting with lower tumor stages, higher RCC differentiation, and non-clear cell histology. Accordingly, the calculated 5 (10)-year OS rates were 90.0 (74.6)% for ePN, 83.9 (57.5)% for iPN, and 81.2 (64.7)% for RN (p < 0.001). However, multivariate analysis including age, sex, tumor diameter and differentiation, histological subtype, and the year of surgery showed that ePN compared to RN still qualified as an independent factor for improved OS (HR 0.79, 95% CI 0.66-0.94, p = 0.008).

Conclusion

Even allowing for the weaknesses of this retrospective analysis, our multicenter study indicates that in patients with localized RCC, PN appears to be associated with better OS than RN irrespective of age or tumor size.
Appendix
Available only for authorised users
Literature
1.
Ljungberg B, Cowan NC, Hanbury DC, Hora M, Kuczyk MA, Merseburger AS, Patard JJ, Mulders PF, Sinescu IC: EAU guidelines on renal cell carcinoma: the 2010 update. Eur Urol. 2010, 58 (3): 398-406. 10.1016/j.eururo.2010.06.032.CrossRefPubMed
2.
Terrone C, Volpe A: Can emerging level 1 evidence “discourage” elective nephron-sparing surgery for small renal tumors?. Eur Urol. 2011, 59 (4): 553-555. 10.1016/j.eururo.2010.12.041.CrossRefPubMed
3.
Sun M, Abdollah F, Bianchi M, Trinh QD, Jeldres C, Thuret R, Tian Z, Shariat SF, Montorsi F, Perrotte P, Karakiewicz PI: Treatment management of small renal masses in the 21st century: a paradigm shift. Annals of surgical oncology. 2012, 19 (7): 2380-2387. 10.1245/s10434-012-2247-0.CrossRefPubMed
4.
Van Poppel H, Becker F, Cadeddu JA, Gill IS, Janetschek G, Jewett MA, Laguna MP, Marberger M, Montorsi F, Polascik TJ, Okimura O, Zhu G: Treatment of localised renal cell carcinoma. Eur Urol. 2011, 60 (4): 662-672. 10.1016/j.eururo.2011.06.040.CrossRefPubMed
5.
Antonelli A, Ficarra V, Bertini R, Carini M, Carmignani G, Corti S, Longo N, Martorana G, Minervini A, Mirone V, Novara G, Serni S, Simeone C, Simonato A, Siracusano S, Volpe A, Zattoni F, Cunico SC: Elective partial nephrectomy is equivalent to radical nephrectomy in patients with clinical T1 renal cell carcinoma: results of a retrospective, comparative, multi-institutional study. BJU Int. 2012, 109 (7): 1013-1018. 10.1111/j.1464-410X.2011.10431.x.CrossRefPubMed
6.
Minervini A, Serni S, Tuccio A, Siena G, Vittori G, Masieri L, Giancane S, Lanciotti M, Khorrami S, Lapini A, Carini M: Simple enucleation versus radical nephrectomy in the treatment of pT1a and pT1b renal cell carcinoma. Annals of surgical oncology. 2012, 19 (2): 694-700. 10.1245/s10434-011-2003-x.CrossRefPubMed
7.
Steffens S, Junker K, Roos FC, Janssen M, Becker F, Henn D, Wegener G, Siemer S, Hofmann R, Schrader M, Stöckle M, Thüroff JW, Hartmann A, Kuczyk MA, Schrader AJ: Small renal cell carcinomas - How dangerous are they really? Results of a large multicenter study. Eur J Cancer. 2014, 4: 739-745.CrossRef
8.
Van Poppel H, Da Pozzo L, Albrecht W, Matveev V, Bono A, Borkowski A, Marechal JM, Klotz L, Skinner E, Keane T, Claessens I, Sylvester R: A prospective randomized EORTC intergroup phase 3 study comparing the complications of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol. 2007, 51 (6): 1606-1615. 10.1016/j.eururo.2006.11.013.CrossRefPubMed
9.
Campbell SC, Novick AC, Belldegrun A, Blute ML, Chow GK, Derweesh IH, Faraday MM, Kaouk JH, Leveillee RJ, Matin SF, Russo P, Uzzo RG: Guideline for management of the clinical T1 renal mass. J Urol. 2009, 182 (4): 1271-1279. 10.1016/j.juro.2009.07.004.CrossRefPubMed
10.
Coffin G, Hupertan V, Taksin L, Vaessen C, Chartier-Kastler E, Bitker MO, Roupret M: Impact of elective versus imperative indications on oncologic outcomes after open nephron-sparing surgery for the treatment of sporadic renal cell carcinomas. Annals of surgical oncology. 2011, 18 (4): 1151-1157. 10.1245/s10434-010-1457-6.CrossRefPubMed
11.
Peycelon M, Hupertan V, Comperat E, Renard-Penna R, Vaessen C, Conort P, Bitker MO, Chartier-Kastler E, Richard F, Roupret M: Long-term outcomes after nephron sparing surgery for renal cell carcinoma larger than 4 cm. J Urol. 2009, 181 (1): 35-41. 10.1016/j.juro.2008.09.025.CrossRefPubMed
12.
Hansen J, Sun M, Bianchi M, Rink M, Tian Z, Hanna N, Meskawi M, Schmitges J, Shariat SF, Chun FK, Perrotte P, Graefen M, Karakiewicz PI: Assessment of cancer control outcomes in patients with high-risk renal cell carcinoma treated with partial nephrectomy. Urology. 2012, 80 (2): 347-353. 10.1016/j.urology.2012.04.043.CrossRefPubMed
13.
Becker F, Roos FC, Janssen M, Brenner W, Hampel C, Siemer S, Thuroff JW, Stockle M: Short-term functional and oncologic outcomes of nephron-sparing surgery for renal tumours >/=7 cm. Eur Urol. 2011, 59 (6): 931-937. 10.1016/j.eururo.2011.02.017.CrossRefPubMed
14.
Huang WC, Elkin EB, Levey AS, Jang TL, Russo P: Partial nephrectomy versus radical nephrectomy in patients with small renal tumors–is there a difference in mortality and cardiovascular outcomes?. J Urol. 2009, 181 (1): 55-61. 10.1016/j.juro.2008.09.017. discussion 61–52CrossRefPubMed
15.
Thompson RH, Boorjian SA, Lohse CM, Leibovich BC, Kwon ED, Cheville JC, Blute ML: Radical nephrectomy for pT1a renal masses may be associated with decreased overall survival compared with partial nephrectomy. J Urol. 2008, 179 (2): 468-471. 10.1016/j.juro.2007.09.077. discussion 472–463CrossRefPubMed
16.
Weight CJ, Lieser G, Larson BT, Gao T, Lane BR, Campbell SC, Gill IS, Novick AC, Fergany AF: Partial nephrectomy is associated with improved overall survival compared to radical nephrectomy in patients with unanticipated benign renal tumours. Eur Urol. 2010, 58 (2): 293-298. 10.1016/j.eururo.2010.04.033.CrossRefPubMed
17.
MacLennan S, Imamura M, Lapitan MC, Omar MI, Lam TB, Hilvano-Cabungcal AM, Royle P, Stewart F, MacLennan G, MacLennan SJ, Canfield SE, McClinton S, Griffiths TR, Ljungberg B, N'Dow J: Systematic review of oncological outcomes following surgical management of localised renal cancer. Eur Urol. 2012, 61 (5): 972-993. 10.1016/j.eururo.2012.02.039.CrossRefPubMed
18.
Huang WC, Levey AS, Serio AM, Snyder M, Vickers AJ, Raj GV, Scardino PT, Russo P: Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lancet Oncol. 2006, 7 (9): 735-740. 10.1016/S1470-2045(06)70803-8.CrossRefPubMedPubMedCentral
19.
Klarenbach S, Moore RB, Chapman DW, Dong J, Braam B: Adverse renal outcomes in subjects undergoing nephrectomy for renal tumors: a population-based analysis. Eur Urol. 2011, 59 (3): 333-339. 10.1016/j.eururo.2010.11.013.CrossRefPubMed
20.
Scosyrev E, Messing EM, Sylvester R, Campbell S, Van Poppel H: Renal Function After Nephron-sparing Surgery Versus Radical Nephrectomy: Results from EORTC Randomized Trial 30904. Eur Urol. 2013, in press
21.
Miller DC, Schonlau M, Litwin MS, Lai J, Saigal CS, Urologic Diseases in America P: Renal and cardiovascular morbidity after partial or radical nephrectomy. Cancer. 2008, 112 (3): 511-520. 10.1002/cncr.23218.CrossRefPubMed
22.
Campbell SC: Words of wisdom. Re: a prospective, randomized EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol. 2012, 62 (3): 564-565.CrossRefPubMed
23.
Lane BR, Campbell SC, Demirjian S, Fergany AF: Surgically induced chronic kidney disease may be associated with a lower risk of progression and mortality than medical chronic kidney disease. J Urol. 2013, 189 (5): 1649-1655. 10.1016/j.juro.2012.11.121.CrossRefPubMed
24.
Van Poppel H, Da Pozzo L, Albrecht W, Matveev V, Bono A, Borkowski A, Colombel M, Klotz L, Skinner E, Keane T, Marreaud S, Collette S, Sylvester R: A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol. 2011, 59 (4): 543-552. 10.1016/j.eururo.2010.12.013.CrossRefPubMed
25.
Robson CJ, Churchill BM, Anderson W: The results of radical nephrectomy for renal cell carcinoma. J Urol. 1969, 101 (3): 297-301.PubMed
26.
Schnoeller TJ, de Petriconi R, Hefty R, Jentzmik F, Waalkes S, Zengerling F, Schrader M, Schrader AJ: Partial nephrectomy using porcine small intestinal submucosa. World J Surg Oncol. 2011, 9 (126): 1-5.
27.
Weight CJ, Larson BT, Gao T, Campbell SC, Lane BR, Kaouk JH, Gill IS, Klein EA, Fergany AF: Elective partial nephrectomy in patients with clinical T1b renal tumors is associated with improved overall survival. Urology. 2010, 76 (3): 631-637. 10.1016/j.urology.2009.11.087.CrossRefPubMed
28.
Kates M, Badalato GM, Pitman M, McKiernan JM: Increased risk of overall and cardiovascular mortality after radical nephrectomy for renal cell carcinoma 2 cm or less. J Urol. 2011, 186 (4): 1247-53. 10.1016/j.juro.2011.05.054.CrossRefPubMed
29.
Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY: Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004, 351 (13): 1296-1305. 10.1056/NEJMoa041031.CrossRefPubMed
30.
Kim SP, Thompson RH, Boorjian SA, Weight CJ, Han LC, Murad MH, Shippee ND, Erwin PJ, Costello BA, Chow GK, Leibovich BC: Comparative effectiveness for survival and renal function of partial and radical nephrectomy for localized renal tumors: a systematic review and meta-analysis. J Urol. 2012, 188 (1): 51-57. 10.1016/j.juro.2012.03.006.CrossRefPubMed
31.
Becker F, Siemer S, Hack M, Humke U, Ziegler M, Stockle M: Excellent long-term cancer control with elective nephron-sparing surgery for selected renal cell carcinomas measuring more than 4 cm. Eur Urol. 2006, 49 (6): 1058-1063. 10.1016/j.eururo.2006.03.003. discussion 1063–1054CrossRefPubMed
32.
Hillyer SP, Autorino R, Spana G, Guillotreau J, Stein RJ, Haber GP, Kaouk JH: Perioperative outcomes of robotic-assisted partial nephrectomy in elderly patients: a matched-cohort study. Urology. 2012, 79 (5): 1063-1067. 10.1016/j.urology.2011.12.056.CrossRefPubMed
33.
Smaldone MC, Egleston B, Uzzo RG, Kutikov A: Does partial nephrectomy result in a durable overall survival benefit in the Medicare population?. J Urol. 2012, 188 (6): 2089-2094. 10.1016/j.juro.2012.07.099.CrossRefPubMed
34.
Chang SL, Cipriano LE, Brunelli SM, Chung BI: Economic and clinical consequences of new onset post-operative chronic kidney disease following radical and partial nephrectomy in the management of small renal masses. J Urol. 2011, 185 (4S): e612-e613. abstract 1526CrossRef
35.
Shuch B, Hanley J, Lai J, Vourganti S, Kim SP, Setodji CM, Dick AW, Chow WH, Saigal C, Urologic Diseases in America P: Overall survival advantage with partial nephrectomy: a bias of observational data?. Cancer. 2013, 119 (16): 2981-2989. 10.1002/cncr.28141.CrossRefPubMed
36.
Laguna MP: Re: overall survival advantage with partial nephrectomy: a bias of observational data?. J Urol. 2014, 191 (2): 346-347. 10.1016/j.juro.2013.10.090.CrossRefPubMed
37.
Buethe DD, Moussly S, Lin HY, Yue B, Rodriguez AR, Spiess PE, Sexton WJ: Is the R.E.N.A.L. nephrometry scoring system predictive of the functional efficacy of nephron sparing surgery in the solitary kidney?. J Urol. 2012, 188 (3): 729-735. 10.1016/j.juro.2012.04.115.CrossRefPubMed
38.
Hew MN, Baseskioglu B, Barwari K, Axwijk PH, Can C, Horenblas S, Bex A, Rosette JJ, Pes MP: Critical appraisal of the PADUA classification and assessment of the R.E.N.A.L. nephrometry score in patients undergoing partial nephrectomy. J Urol. 2011, 186 (1): 42-46. 10.1016/j.juro.2011.03.020.CrossRefPubMed
39.
Minervini A, Vittori G, Salvi M, Sebastianelli A, Tuccio A, Siena G, Masieri L, Gacci M, Lapini A, Serni S, Carini M: Analysis of surgical complications of renal tumor enucleation with standardized instruments and external validation of PADUA classification. Annals of surgical oncology. 2013, 20 (5): 1729-1736. 10.1245/s10434-012-2801-9.CrossRefPubMed
Metadata
Title
Survival advantage of partial over radical nephrectomy in patients presenting with localized renal cell carcinoma
Authors
Frederik C Roos
Sandra Steffens
Kerstin Junker
Martin Janssen
Frank Becker
Gerd Wegener
Walburgis Brenner
Julie Steinestel
Thomas J Schnoeller
Mark Schrader
Rainer Hofmann
Joachim W Thüroff
Markus A Kuczyk
Heiko Wunderlich
Stefan Siemer
Arndt Hartmann
Michael Stöckle
Andres J Schrader
For the German Renal Cell Cancer Network
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2014
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/1471-2407-14-372

Other articles of this Issue 1/2014

BMC Cancer 1/2014 Go to the issue

Study protocol

A phase II clinical trial of 6-mercaptopurine (6MP) and methotrexate in patients with BRCA defective tumours: a study protocol

Research article

Incidence and outcome for patients with occult lymph node involvement in T1 and T2 oral squamous cell carcinoma: a prospective study

Research article

A grey literature review of special events for promoting cancer screenings

Research article

Tyrosine phosphorylation profiling via in situproximity ligation assay

Research article

The off-label use of targeted therapies in sarcomas: the OUTC’S program

Research article

Systemic neutralization of IL-17A significantly reduces breast cancer associated metastasis in arthritic mice by reducing CXCL12/SDF-1 expression in the metastatic niches
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine
Image Credits