Jae Seung Chung1, Nak Hoon Son2, Sang Eun Lee3, Sung Kyu Hong3, Sang Chul Lee3, Cheol Kwak4, Sung Hoo Hong5, Yong June Kim6, Seok Ho Kang7, Seok-Soo Byun8. 1. Department of Urology, Inje University Haeundae Paik Hospital, Busan, Republic of Korea. 2. Department of Biostatistics, Yonsei University, Seoul, Republic of Korea. 3. Department of Urology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea. 4. Department of Urology, Seoul National University Hospital, Seoul, Republic of Korea. 5. Department of Urology, Seoul St. Mary's Hospital, Seoul, Republic of Korea. 6. Department of Urology, Chungbuk National University Hospital, Cheongju, Republic of Korea. 7. Department of Urology, Korea University Anam Hospital, Seoul, Republic of Korea. 8. Department of Urology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea. Electronic address: ssbyun@snubh.org.
Abstract
BACKGROUND: This study aimed to evaluate the overall survival (OS) rate and renal function after radical nephrectomy (RN) and partial nephrectomy (PN) in patients aged ⩾65years. METHODS: Patients who underwent RN (n=622) or PN (n=622) for renal cell carcinoma (pT1N0M0) between 1999 and 2011 were propensity-score matched in our multicentre database. To investigate the relative effect of PN on OS according to age, we divided the patients into two age subgroups (<65 and ⩾65years). The 5-year OS rates and probabilities of freedom from chronic kidney disease (CKD III or IV) were estimated using the Kaplan-Meier method and separate Cox proportional hazards models. RESULTS: The 5-year OS rates after surgery were 94.7% for PN and 91.9% for RN in the older patients (P=0.698). The corresponding rates in the younger patients were 99.7% for PN and 96.3% for RN (P=0.015). In separate Cox hazards models for OS, the older patients who underwent PN were not significantly different from their RN-treated counterparts (hazard ratio (HR): 0.960; 95% confidence interval (CI): 0.277-2.321, P=0.797). Kidney function was significantly better preserved after PN than after RN at all ages. However, stage IV CKD in the older patients did not occur more frequently in the RN arm than in the PN arm. CONCLUSIONS: Although PN was associated with improved renal function compared with RN, it did not confer a benefit of higher survival rate in elderly patients (⩾65yearsold).
BACKGROUND: This study aimed to evaluate the overall survival (OS) rate and renal function after radical nephrectomy (RN) and partial nephrectomy (PN) in patients aged ⩾65years. METHODS:Patients who underwent RN (n=622) or PN (n=622) for renal cell carcinoma (pT1N0M0) between 1999 and 2011 were propensity-score matched in our multicentre database. To investigate the relative effect of PN on OS according to age, we divided the patients into two age subgroups (<65 and ⩾65years). The 5-year OS rates and probabilities of freedom from chronic kidney disease (CKD III or IV) were estimated using the Kaplan-Meier method and separate Cox proportional hazards models. RESULTS: The 5-year OS rates after surgery were 94.7% for PN and 91.9% for RN in the older patients (P=0.698). The corresponding rates in the younger patients were 99.7% for PN and 96.3% for RN (P=0.015). In separate Cox hazards models for OS, the older patients who underwent PN were not significantly different from their RN-treated counterparts (hazard ratio (HR): 0.960; 95% confidence interval (CI): 0.277-2.321, P=0.797). Kidney function was significantly better preserved after PN than after RN at all ages. However, stage IV CKD in the older patients did not occur more frequently in the RN arm than in the PN arm. CONCLUSIONS: Although PN was associated with improved renal function compared with RN, it did not confer a benefit of higher survival rate in elderly patients (⩾65yearsold).
Authors: Maria C Mir; Nicola Pavan; Umberto Capitanio; Alessandro Antonelli; Ithaar Derweesh; Oscar Rodriguez-Faba; Estefania Linares; Toshio Takagi; Koon H Rha; Christian Fiori; Tobias Maurer; Chao Zang; Alexandre Mottrie; Paolo Umari; Jean-Alexandre Long; Gaelle Fiard; Cosimo De Nunzio; Andrea Tubaro; Andrew T Tracey; Matteo Ferro; Ottavio De Cobelli; Salvatore Micali; Luigi Bevilacqua; João Torres; Luigi Schips; Roberto Castellucci; Ryan Dobbs; Giuseppe Quarto; Pierluigi Bove; Antonio Celia; Bernardino De Concilio; Carlo Trombetta; Tommaso Silvestri; Alessandro Larcher; Francesco Montorsi; Carlotta Palumbo; Maria Furlan; Ahmet Bindayi; Zachary Hamilton; Alberto Breda; Joan Palou; Alfredo Aguilera; Kazunari Tanabe; Ali Raheem; Thomas Amiel; Bo Yang; Estevão Lima; Simone Crivellaro; Sisto Perdona; Caterina Gregorio; Giulia Barbati; Francesco Porpiglia; Riccardo Autorino Journal: World J Urol Date: 2019-04-01 Impact factor: 4.226
Authors: Hiten D Patel; Phillip M Pierorazio; Michael H Johnson; Ritu Sharma; Emmanuel Iyoha; Mohamad E Allaf; Eric B Bass; Stephen M Sozio Journal: Clin J Am Soc Nephrol Date: 2017-05-08 Impact factor: 8.237
Authors: Frank Kunath; Stefanie Schmidt; Laura-Maria Krabbe; Arkadiusz Miernik; Philipp Dahm; Anne Cleves; Mario Walther; Nils Kroeger Journal: Cochrane Database Syst Rev Date: 2017-05-09