Connor M Forbes1, Ricardo A Rendon2, Antonio Finelli3, Anil Kapoor4, Ronald B Moore5, Rodney H Breau6, Louis Lacombe7, Jun Kawakami8, Darrel E Drachenberg9, Stephen E Pautler10, Michael M A Jewett3, Olli Saarela11, Zhihui Liu11, Simon Tanguay12, Peter C Black13. 1. Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada. 2. Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada. 3. Department of Surgery (Urology), Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada. 4. Division of Urology, McMaster University, Hamilton, Ontario, Canada. 5. Department of Urology, University of Alberta, Edmonton, Alberta, Canada. 6. Division of Urology, University of Ottawa, Ottawa, Ontario, Canada. 7. Department of Surgery (Urology), Laval University, Quebec City, Quebec, Canada. 8. Division of Urology, University of Calgary, Calgary, Alberta, Canada. 9. Section of Urology, University of Manitoba, Winnipeg, Manitoba, Canada. 10. Division of Urology, Western University, London, Ontario, Canada. 11. Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. 12. Division of Urology, McGill University, Montreal, Québec, Canada. 13. Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: pblack@mail.ubc.ca.
Abstract
PURPOSE: Partial nephrectomy (PN) for early stage renal cancer preserves renal function better than radical nephrectomy (RN) and is generally considered oncologically similar. The Intergroup European Organisation for Research and Treatment of Cancer trial comparing outcomes after PN vs. RN, however, showed reduced overall survival in the PN group. Our aim was to evaluate recurrence, death, and renal function after PN vs. RN for T1 tumors in a Canadian population. MATERIALS AND METHODS: From 2000 to 2015, 2,358 patients with a first occurrence of a clinical T1 renal cancer who underwent PN or RN were identified from the Canadian Kidney Cancer Information System. Clinical, surgical, and pathologic parameters were analyzed. Time to progression was compared after PN vs. RN using a Cox proportional hazards model, adjusted for pertinent variables. RESULTS: Inclusion criteria were met in 1,615 PN and 743 RN. Preoperative characteristics appeared similar in both groups. Time to progression was not different after PN vs. RN, adjusted for potential confounders (hazard ratio = 1.17 [95% CI: 0.8-1.72, P = 0.42]). Postoperative estimated glomerular filtration rate at 1 and 3 years was significantly greater for PN vs. RN in a linear regression model, accounting for preoperative estimated glomerular filtration rate. CONCLUSIONS: These results suggest that progression-free survival after PN and RN in patients with T1 renal cancer was similar, but that there was better preservation of renal function after PN. This suggests that both PN and RN have similar oncological efficiency, and that selection of surgical approach should be based on other factors such as technical feasibility, potential complications, and preservation of renal function.
PURPOSE: Partial nephrectomy (PN) for early stage renal cancer preserves renal function better than radical nephrectomy (RN) and is generally considered oncologically similar. The Intergroup European Organisation for Research and Treatment of Cancer trial comparing outcomes after PN vs. RN, however, showed reduced overall survival in the PN group. Our aim was to evaluate recurrence, death, and renal function after PN vs. RN for T1 tumors in a Canadian population. MATERIALS AND METHODS: From 2000 to 2015, 2,358 patients with a first occurrence of a clinical T1 renal cancer who underwent PN or RN were identified from the Canadian Kidney Cancer Information System. Clinical, surgical, and pathologic parameters were analyzed. Time to progression was compared after PN vs. RN using a Cox proportional hazards model, adjusted for pertinent variables. RESULTS: Inclusion criteria were met in 1,615 PN and 743 RN. Preoperative characteristics appeared similar in both groups. Time to progression was not different after PN vs. RN, adjusted for potential confounders (hazard ratio = 1.17 [95% CI: 0.8-1.72, P = 0.42]). Postoperative estimated glomerular filtration rate at 1 and 3 years was significantly greater for PN vs. RN in a linear regression model, accounting for preoperative estimated glomerular filtration rate. CONCLUSIONS: These results suggest that progression-free survival after PN and RN in patients with T1 renal cancer was similar, but that there was better preservation of renal function after PN. This suggests that both PN and RN have similar oncological efficiency, and that selection of surgical approach should be based on other factors such as technical feasibility, potential complications, and preservation of renal function.
Authors: Alice Dragomir; Armen Aprikian; Anil Kapoor; Antonio Finelli; Frédéric Pouliot; Ricardo Rendon; Peter C Black; Ronald Moore; Rodney H Breau; Jun Kawakami; Darrell Drachenberg; Jean-Baptiste Lattouf; Simon Tanguay Journal: CMAJ Open Date: 2017-12-11
Authors: Anand Mohapatra; Aaron M Potretzke; John Weaver; Barrett G Anderson; Joel Vetter; Robert S Figenshau Journal: J Kidney Cancer VHL Date: 2017-07-20
Authors: João Paulo Pretti Fantin; Ronaldo de Carvalho Neiva; Marcio Gatti; Pedro Ferraz de Arruda; José Germano Ferraz de Arruda; Thiago Antoniassi; Luís Cesar Fava Spessoto; José Carlos Mesquita; Lilian Castiglioni; Fernando-Nestor Fácio-Júnior Journal: Transl Androl Urol Date: 2017-04