Partial Versus Radical Nephrectomy in Patients With Adverse Clinical or Pathologic Characteristics
2009; Elsevier BV; Volume: 73; Issue: 6 Linguagem: Inglês
10.1016/j.urology.2008.08.492
ISSN1527-9995
AutoresClaudio Jeldres, Jean‐Jacques Patard, Umberto Capitanio, Paul Perrotte, Nazareno Suardi, Maxime Crépel, Vincenzo Ficarra, Luca Cindolo, Alexandre de la Taille, Jacques Tostain, Christian Pfister, Baptiste Albouy, Marc Colombel, Arnaud Méjean, Hervé Lang, Didier Jacqmin, Jean‐Christophe Bernhard, J. Ferrière, Karim Bensalah, Pierre I. Karakiewicz,
Tópico(s)Bladder and Urothelial Cancer Treatments
ResumoTo assess cancer-specific survival of partial nephrectomy (PN) patients with >or= 7-cm lesions or unfavorable pathology (stage T3a or Fuhrman grades III-IV).At 13 participation centers, 4072 partial or radical nephrectomies (RN) were performed for RCC between 1984 and 2001. Of all procedures, 925 (22.7%) were for tumors > 7 cm, 973 (23.9%) had Fuhrman grades III or IV, and 861 (21.1%) had stage pT3a. None had nodal or distant metastases. Matched (age, gender, tumor size, T stage, histologic subtype, and Fuhrman grade [FG]) survival analyses addressed the effect of nephrectomy type (partial vs radical) on cancer-specific mortality.Partial nephrectomy for tumors > 7 cm was associated with higher mortality than RN (HR = 5.3; P = .025). No significant cancer-specific survival differences were recorded after PN for FG III-IV (HR = 0.7, P = .5) or for pT3a lesions (HR = 2.5, P = .9).Partial nephrectomy may undermine cancer control in patients with tumors > 7 cm. Conversely, after PN, the same cancer control rates as after RN may be expected in patients with Fuhrman grades III-IV or with pT3a histology.
Referência(s)