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Nephron Sparing Surgery for Appropriately Selected Renal Cell Carcinoma Between 4 and 7 Cm Results in Outcome Similar to Radical Nephrectomy

2004; Lippincott Williams & Wilkins; Volume: 171; Issue: 3 Linguagem: Inglês

10.1097/01.ju.0000113274.40885.db

1527-3792

Bradley C. Leibovich, Michael L. Blute, John C. Cheville, Christine M. Lohse, Amy L. Weaver, Horst Zincke,

Bladder and Urothelial Cancer Treatments

No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Mar 2004Nephron Sparing Surgery for Appropriately Selected Renal Cell Carcinoma Between 4 and 7 Cm Results in Outcome Similar to Radical Nephrectomyis corrected byRE: NEPHRON SPARING SURGERY FOR APPROPRIATELY SELECTED RENAL CELL CARCINOMA BETWEEN 4 AND 7 CM RESULTS IN OUTCOME SIMILAR TO RADICAL NEPHRECTOMYRE: NEPHRON SPARING SURGERY FOR APPROPRIATELY SELECTED RENAL CELL CARCINOMA BETWEEN 4 AND 7 CM RESULTS IN OUTCOME SIMILAR TO RADICAL NEPHRECTOMY BRADLEY C. LEIBOVICH, MICHAEL L. BLUTE, JOHN C. CHEVILLE, CHRISTINE M. LOHSE, AMY L. WEAVER, and HORST ZINCKE BRADLEY C. LEIBOVICHBRADLEY C. LEIBOVICH , MICHAEL L. BLUTEMICHAEL L. BLUTE , JOHN C. CHEVILLEJOHN C. CHEVILLE , CHRISTINE M. LOHSECHRISTINE M. LOHSE , AMY L. WEAVERAMY L. WEAVER , and HORST ZINCKEHORST ZINCKE View All Author Informationhttps://doi.org/10.1097/01.ju.0000113274.40885.dbAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We compared outcomes between patients treated with nephron sparing surgery (NSS) without imperative indications for renal preservation and radical nephrectomy (RN) for 4 to 7 cm renal cell carcinoma (RCC). Materials and Methods: We identified 91 patients treated with NSS and 841 patients treated with RN for 4 to 7 cm RCC between 1970 and 2000. Cancer specific, distant metastases-free and recurrence-free survivals were estimated using the Kaplan-Meier method. Results: Cancer specific survival rates at 5 years for patients treated with NSS and RN for 4 to 7 cm RCC were 98% and 86%, respectively. On univariate analysis patients treated with RN for 4 to 7 cm RCC were more likely to die of RCC compared to patients treated with NSS. However, after adjusting for features associated with death from RCC including stage, grade, histological tumor necrosis and histological subtype, this difference was no longer statistically significant (risk ratio 1.60, 95% CI 0.50–5.12, p = 0.430). Distant metastases-free survival rates at 5 years for patients treated with NSS and RN were 94% and 83%, respectively. On univariate analysis patients treated with RN were more likely to have tumors that metastasized compared to patients treated with NSS, although this difference was no longer significant after adjusting for the features listed previously (risk ratio 1.76, 95% CI 0.64–4.83, p = 0.273). Recurrence-free survival rates at 5 years for patients treated with NSS and RN were 94% and 98%, respectively. On univariate analysis patients treated with RN were less likely to have recurrence compared to patients treated with NSS (risk ratio 0.32, 95% CI 0.12–0.85, p = 0.022). Conclusions: There were no statistically significant differences in cancer specific survival and distant metastases-free survival between patients treated with NSS and RN for 4 to 7 cm RCC after adjusting for important pathological features. NSS for 4 to 7 cm RCC results in excellent outcome in appropriately selected patients. References 1 : Matched comparison of radical nephrectomy vs nephron-sparing surgery in patients with unilateral renal cell carcinoma and a normal contralateral kidney. Mayo Clin Proc2000; 75: 1236. Google Scholar 2 : Quality of life and psychological adaptation after surgical treatment for localized renal cell carcinoma: impact of the amount of remaining renal tissue. Urology2001; 57: 252. Google Scholar 3 : Surgical management of renal tumors 4 cm. or less in a contemporary cohort. J Urol2000; 163: 730. Link, Google Scholar 4 : Disease outcome in patients with low stage renal cell carcinoma treated with nephron sparing or radical surgery. J Urol1996; 155: 1868. 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LEIBOVICH More articles by this author MICHAEL L. BLUTE More articles by this author JOHN C. CHEVILLE More articles by this author CHRISTINE M. LOHSE More articles by this author AMY L. WEAVER More articles by this author HORST ZINCKE More articles by this author Expand All Advertisement PDF downloadLoading ...