Treatment for T1a Renal Cancer Substratified by Size: “Less is More”
2016; Lippincott Williams & Wilkins; Volume: 196; Issue: 4 Linguagem: Inglês
10.1016/j.juro.2016.04.063
ISSN1527-3792
AutoresDena Moskowitz, Jenny Chang, Argyrios Ziogas, Hoda Anton‐Culver, Ralph V. Clayman,
Tópico(s)Renal and Vascular Pathologies
ResumoNo AccessJournal of UrologyAdult Urology1 Oct 2016Treatment for T1a Renal Cancer Substratified by Size: "Less is More" Dena Moskowitz, Jenny Chang, Argyrios Ziogas, Hoda Anton-Culver, and Ralph V. Clayman Dena MoskowitzDena Moskowitz Department of Urology, University of California, Irvine, Irvine, California , Jenny ChangJenny Chang Department of Epidemiology, University of California, Irvine, Irvine, California , Argyrios ZiogasArgyrios Ziogas Department of Epidemiology, University of California, Irvine, Irvine, California , Hoda Anton-CulverHoda Anton-Culver Department of Epidemiology, University of California, Irvine, Irvine, California , and Ralph V. ClaymanRalph V. Clayman Department of Urology, University of California, Irvine, Irvine, California View All Author Informationhttps://doi.org/10.1016/j.juro.2016.04.063AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Due to the widespread use of computerized tomography, the diagnosis of small renal cancers (3 cm or less) within the T1a classification continues to increase. Current treatment of these tumors includes radical nephrectomy, partial nephrectomy and thermal ablation. We used the SEER (Surveillance, Epidemiology, and End Results) Program to compare treatment modalities for these cancers based on 1 cm increments in tumor size. We examined overall survival, cancer specific survival, survival from cardiovascular disease and race based treatment disparities. Materials and Methods: In the SEER database we identified 17,716 renal cancers 3 cm or less diagnosed from 2005 to 2010 treated with radical nephrectomy, partial nephrectomy or thermal ablation. Overall survival, cancer specific survival and cardiovascular survival were determined for each treatment group, and then substratified by size in centimeters, tumor grade, age, geographical location and ethnicity. Survival was analyzed using Kaplan-Meier methods, multivariate proportional hazards models and a propensity score weighted approach. Results: Overall survival, cancer specific survival and cardiovascular survival were better for partial nephrectomy than radical nephrectomy in all circumstances. Thermal ablation showed equivalent overall survival to partial nephrectomy for tumors 2 cm or less. Notably, radical nephrectomy for renal tumors 3 cm or less was applied in a disparately larger number of black patients (OR 1.63, 95% CI 1.47–1.81) and Hispanic patients (OR 1.28, 95% CI 1.14–1.44). Conclusions: Radical nephrectomy should be avoided for all tumors 3 cm or less. For renal cancers 2 cm or less partial nephrectomy and thermal ablation are equally effective. For tumors 2.1 to 3 cm partial nephrectomy is better than thermal ablation. We identified significant racial treatment disparities that negatively impact survival in black and Hispanic patients. References 1 : Natural history of chronic renal insufficiency after partial and radical nephrectomy. Urology2002; 59: 816. Google Scholar 2 : Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lancet Oncol2006; 7: 735. 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Google Scholar © 2016 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byLaguna M (2019) Re: The Probability of Aggressive versus Indolent Histology Based on Renal Tumor Size: Implications for Surveillance and TreatmentJournal of Urology, VOL. 201, NO. 5, (856-856), Online publication date: 1-May-2019. Volume 196Issue 4October 2016Page: 1000-1007 Advertisement Copyright & Permissions© 2016 by American Urological Association Education and Research, Inc.Keywordskidney neoplasmsablation techniquesnephrectomyMetricsAuthor Information Dena Moskowitz Department of Urology, University of California, Irvine, Irvine, California More articles by this author Jenny Chang Department of Epidemiology, University of California, Irvine, Irvine, California More articles by this author Argyrios Ziogas Department of Epidemiology, University of California, Irvine, Irvine, California More articles by this author Hoda Anton-Culver Department of Epidemiology, University of California, Irvine, Irvine, California More articles by this author Ralph V. Clayman Department of Urology, University of California, Irvine, Irvine, California More articles by this author Expand All Advertisement PDF downloadLoading ...
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