Elective Nephron Sparing Surgery Decreases Other Cause Mortality Relative to Radical Nephrectomy Only in Specific Subgroups of Patients with Renal Cell Carcinoma
2016; Lippincott Williams & Wilkins; Volume: 196; Issue: 4 Linguagem: Inglês
10.1016/j.juro.2016.04.093
ISSN1527-3792
AutoresAlessandro Larcher, Umberto Capitanio, Carlo Terrone, Alessandro Volpe, Paolo De Angelis, Federico Dehò, Nicola Fossati, Paolo Dell’Oglio, Alessandro Antonelli, Maria Furlan, Claudio Simeone, Sergio Serni, Marco Carini, Andrea Minervini, Cristian Fiori, Francesco Porpiglia, Alberto Briganti, Francesco Montorsi, Roberto Bertini,
Tópico(s)Bladder and Urothelial Cancer Treatments
ResumoNo AccessJournal of UrologyAdult Urology1 Oct 2016Elective Nephron Sparing Surgery Decreases Other Cause Mortality Relative to Radical Nephrectomy Only in Specific Subgroups of Patients with Renal Cell Carcinoma Alessandro Larcher, Umberto Capitanio, Carlo Terrone, Alessandro Volpe, Paolo De Angelis, Federico Dehó, Nicola Fossati, Paolo Dell’Oglio, Alessandro Antonelli, Maria Furlan, Claudio Simeone, Sergio Serni, Marco Carini, Andrea Minervini, Cristian Fiori, Francesco Porpiglia, Alberto Briganti, Francesco Montorsi, and Roberto Bertini Alessandro LarcherAlessandro Larcher Urological Research Institute, Division of Experimental Oncology, Istituto di Ricovero e Cura a Carattere Scientifico and Unit of Urology, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy More articles by this author , Umberto CapitanioUmberto Capitanio Urological Research Institute, Division of Experimental Oncology, Istituto di Ricovero e Cura a Carattere Scientifico and Unit of Urology, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy More articles by this author , Carlo TerroneCarlo Terrone Department of Urology, University of Piemonte Orientale, Novara, Italy More articles by this author , Alessandro VolpeAlessandro Volpe Department of Urology, University of Piemonte Orientale, Novara, Italy More articles by this author , Paolo De AngelisPaolo De Angelis Department of Urology, University of Piemonte Orientale, Novara, Italy More articles by this author , Federico DehóFederico Dehó Urological Research Institute, Division of Experimental Oncology, Istituto di Ricovero e Cura a Carattere Scientifico and Unit of Urology, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy More articles by this author , Nicola FossatiNicola Fossati Urological Research Institute, Division of Experimental Oncology, Istituto di Ricovero e Cura a Carattere Scientifico and Unit of Urology, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy More articles by this author , Paolo Dell’OglioPaolo Dell’Oglio Urological Research Institute, Division of Experimental Oncology, Istituto di Ricovero e Cura a Carattere Scientifico and Unit of Urology, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy More articles by this author , Alessandro AntonelliAlessandro Antonelli Department of Urology, Università degli studi e Spedali Civili di Brescia, Brescia, Italy More articles by this author , Maria FurlanMaria Furlan Department of Urology, Università degli studi e Spedali Civili di Brescia, Brescia, Italy More articles by this author , Claudio SimeoneClaudio Simeone Department of Urology, Università degli studi e Spedali Civili di Brescia, Brescia, Italy More articles by this author , Sergio SerniSergio Serni Department of Urology, Clinica Urologica I, Azienda Ospedaliera Universitaria Careggi, Università degli studi di Firenze, Firenze, Italy More articles by this author , Marco CariniMarco Carini Department of Urology, Clinica Urologica I, Azienda Ospedaliera Universitaria Careggi, Università degli studi di Firenze, Firenze, Italy More articles by this author , Andrea MinerviniAndrea Minervini Department of Urology, Clinica Urologica I, Azienda Ospedaliera Universitaria Careggi, Università degli studi di Firenze, Firenze, Italy More articles by this author , Cristian FioriCristian Fiori Department of Urology, Azienda Ospedaliero-Universitaria San Luigi Gonzaga, Università degli studi di Torino, Orbassano, Italy More articles by this author , Francesco PorpigliaFrancesco Porpiglia Department of Urology, Azienda Ospedaliero-Universitaria San Luigi Gonzaga, Università degli studi di Torino, Orbassano, Italy More articles by this author , Alberto BrigantiAlberto Briganti Urological Research Institute, Division of Experimental Oncology, Istituto di Ricovero e Cura a Carattere Scientifico and Unit of Urology, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy More articles by this author , Francesco MontorsiFrancesco Montorsi Urological Research Institute, Division of Experimental Oncology, Istituto di Ricovero e Cura a Carattere Scientifico and Unit of Urology, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy More articles by this author , and Roberto BertiniRoberto Bertini Urological Research Institute, Division of Experimental Oncology, Istituto di Ricovero e Cura a Carattere Scientifico and Unit of Urology, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.04.093AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: There is no consensus regarding a protective effect on mortality due to a cause other than cancer in patients treated with elective nephron sparing surgery relative to their radical nephrectomy counterparts. We test whether the protective effect of nephron sparing surgery relative to radical nephrectomy is universal or present in specific subgroups of patients. Materials and Methods: A collaborative database of 5 institutions was queried to evaluate 1,783 patients without chronic kidney disease diagnosed with a clinical T1 renal mass that was treated with nephron sparing surgery or radical nephrectomy. Multivariable Cox regression analysis was done to assess the impact of surgery type (nephron sparing surgery vs radical nephrectomy) on other cause mortality after adjustment for patient and cancer characteristics. Interaction terms were used to test the hypothesis that the impact of surgery type varies according to specific subcohorts of patients. Results: Ten-year other cause mortality-free survival rates were 90% and 88% after nephron sparing surgery and radical nephrectomy, respectively. In the overall population radical nephrectomy was not associated with an increased risk of other cause mortality on multivariable analysis compared to nephron sparing surgery (HR 0.91, 95% CI 0.6–1.38, p = 0.6). However, radical nephrectomy increased the risk of other cause mortality according to the increasing baseline Charlson comorbidity index (interaction test p = 0.0008). For example, in a patient with a Charlson comorbidity index of 4 the probability of 10-year other cause mortality-free survival was 86% after nephron sparing surgery and 60% after radical nephrectomy. Conclusions: Elective nephron sparing surgery does not improve other cause survival relative to radical nephrectomy consistently in all patients with kidney cancer. Patients who are more ill with relevant comorbidities are those who benefit the most from nephron sparing surgery in terms of other cause mortality. References 1 : EAU Guidelines on renal cell carcinoma: 2014 update. Eur Urol2015; 67: 913. 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Google Scholar © 2016 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byLaguna M (2019) Re: Postoperative Complications Increase the Risk of Long-Term Chronic Kidney Disease after Nephron-Sparing Surgery in Patients with Renal Cancer and Normal Preoperative Renal FunctionJournal of Urology, VOL. 203, NO. 2, (248-249), Online publication date: 1-Feb-2020.Laguna M (2019) Re: Below Safety Limits, Every Unit of Glomerular Filtration Rate Counts: Assessing the Relationship between Renal Function and Cancer-Specific Mortality in Renal Cell CarcinomaJournal of Urology, VOL. 201, NO. 6, (1049-1050), Online publication date: 1-Jun-2019.Antonelli A, Minervini A and Capitanio U (2019) Editorial CommentJournal of Urology, VOL. 201, NO. 6, (1096-1096), Online publication date: 1-Jun-2019.Griebling T (2018) Re: Prediction of Competing Mortality for Decision-Making between Surgery or Observation in Elderly Patients with T1 Kidney CancerJournal of Urology, VOL. 200, NO. 1, (8-9), Online publication date: 1-Jul-2018.Antonelli A, Mari A, Longo N, Novara G, Porpiglia F, Schiavina R, Ficarra V, Carini M and Minervini A (2017) Role of Clinical and Surgical Factors for the Prediction of Immediate, Early and Late Functional Results, and its Relationship with Cardiovascular Outcome after Partial Nephrectomy: Results from the Prospective Multicenter RECORd 1 ProjectJournal of Urology, VOL. 199, NO. 4, (927-932), Online publication date: 1-Apr-2018. (2017) Reply by AuthorsJournal of Urology, VOL. 199, NO. 2, (391-392), Online publication date: 1-Feb-2018. Volume 196Issue 4October 2016Page: 1008-1013 Advertisement Copyright & Permissions© 2016 by American Urological Association Education and Research, Inc.Keywordscarcinoma, renal cellcause of deathnephrectomykidneycomorbidityMetricsAuthor Information Alessandro Larcher Urological Research Institute, Division of Experimental Oncology, Istituto di Ricovero e Cura a Carattere Scientifico and Unit of Urology, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy More articles by this author Umberto Capitanio Urological Research Institute, Division of Experimental Oncology, Istituto di Ricovero e Cura a Carattere Scientifico and Unit of Urology, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy More articles by this author Carlo Terrone Department of Urology, University of Piemonte Orientale, Novara, Italy More articles by this author Alessandro Volpe Department of Urology, University of Piemonte Orientale, Novara, Italy More articles by this author Paolo De Angelis Department of Urology, University of Piemonte Orientale, Novara, Italy More articles by this author Federico Dehó Urological Research Institute, Division of Experimental Oncology, Istituto di Ricovero e Cura a Carattere Scientifico and Unit of Urology, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy More articles by this author Nicola Fossati Urological Research Institute, Division of Experimental Oncology, Istituto di Ricovero e Cura a Carattere Scientifico and Unit of Urology, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy More articles by this author Paolo Dell’Oglio Urological Research Institute, Division of Experimental Oncology, Istituto di Ricovero e Cura a Carattere Scientifico and Unit of Urology, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy More articles by this author Alessandro Antonelli Department of Urology, Università degli studi e Spedali Civili di Brescia, Brescia, Italy More articles by this author Maria Furlan Department of Urology, Università degli studi e Spedali Civili di Brescia, Brescia, Italy More articles by this author Claudio Simeone Department of Urology, Università degli studi e Spedali Civili di Brescia, Brescia, Italy More articles by this author Sergio Serni Department of Urology, Clinica Urologica I, Azienda Ospedaliera Universitaria Careggi, Università degli studi di Firenze, Firenze, Italy More articles by this author Marco Carini Department of Urology, Clinica Urologica I, Azienda Ospedaliera Universitaria Careggi, Università degli studi di Firenze, Firenze, Italy More articles by this author Andrea Minervini Department of Urology, Clinica Urologica I, Azienda Ospedaliera Universitaria Careggi, Università degli studi di Firenze, Firenze, Italy More articles by this author Cristian Fiori Department of Urology, Azienda Ospedaliero-Universitaria San Luigi Gonzaga, Università degli studi di Torino, Orbassano, Italy More articles by this author Francesco Porpiglia Department of Urology, Azienda Ospedaliero-Universitaria San Luigi Gonzaga, Università degli studi di Torino, Orbassano, Italy More articles by this author Alberto Briganti Urological Research Institute, Division of Experimental Oncology, Istituto di Ricovero e Cura a Carattere Scientifico and Unit of Urology, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy More articles by this author Francesco Montorsi Urological Research Institute, Division of Experimental Oncology, Istituto di Ricovero e Cura a Carattere Scientifico and Unit of Urology, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy More articles by this author Roberto Bertini Urological Research Institute, Division of Experimental Oncology, Istituto di Ricovero e Cura a Carattere Scientifico and Unit of Urology, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy More articles by this author Expand All Advertisement PDF downloadLoading ...
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