Daniel C Wang1, Kyle Plante2, Telisa Stewart3, Dongliang Wang2, Margaret Formica3, Michael Daugherty1, Gennady Bratslavsky4. 1. Department of Urology, SUNY Upstate Medical University, Syracuse, NY. 2. Department of Public Health & Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY. 3. Department of Urology, SUNY Upstate Medical University, Syracuse, NY; Department of Public Health & Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY. 4. Department of Urology, SUNY Upstate Medical University, Syracuse, NY. Electronic address: bratslag@upstate.edu.
Abstract
PURPOSE: There is a paucity of data comparing effects of partial nephrectomy (PN) vs. radical nephrectomy (RN) on overall survival in young patients. In this study, the National Cancer Database was used to evaluate the survival outcomes of those treated with PN and RN, and influence of comorbidities on surgical treatment (PN vs. RN) in young patients while accounting for Charlson-Deyo Comorbidity Score (CDCS). MATERIALS AND METHODS: Patients between 20 and 44 years old (n = 9,849) surgically treated for pT1a renal cell carcinoma between 2004 and 2013 were identified from the National Cancer Database. Kaplan-Meier log-rank analysis and Cox proportional hazards model were performed to compare overall survival and calculate the hazard ratio between those undergoing RN and PN. Binary logistic regression was used to calculate odds ratios for receiving RN compared to PN. The effect measures in all models were adjusted for potential confounding factors. RESULTS: After adjusting for comorbidities, PN offered an overall survival advantage over RN (P<0.001, hazard ratio = 0.464, 95% CI: 0.359-0.601) at a mean follow-up of 48.4 months (0-130.96), including young patients with no comorbidities (P<0.001). Compared to those with a CDCS = 0, patients were more likely to be treated with RN if they had a CDCS>1 (odds ratios = 2.049, 95% CI: 1.527-2.750). CONCLUSIONS: Young patients treated with PN demonstrate an overall survival advantage. This survival advantage is observed after an early follow-up even in those without comorbidities. It is still not clear if the survival advantage seen is due to treatment itself or selection bias.
PURPOSE: There is a paucity of data comparing effects of partial nephrectomy (PN) vs. radical nephrectomy (RN) on overall survival in young patients. In this study, the National Cancer Database was used to evaluate the survival outcomes of those treated with PN and RN, and influence of comorbidities on surgical treatment (PN vs. RN) in young patients while accounting for Charlson-Deyo Comorbidity Score (CDCS). MATERIALS AND METHODS:Patients between 20 and 44 years old (n = 9,849) surgically treated for pT1a renal cell carcinoma between 2004 and 2013 were identified from the National Cancer Database. Kaplan-Meier log-rank analysis and Cox proportional hazards model were performed to compare overall survival and calculate the hazard ratio between those undergoing RN and PN. Binary logistic regression was used to calculate odds ratios for receiving RN compared to PN. The effect measures in all models were adjusted for potential confounding factors. RESULTS: After adjusting for comorbidities, PN offered an overall survival advantage over RN (P<0.001, hazard ratio = 0.464, 95% CI: 0.359-0.601) at a mean follow-up of 48.4 months (0-130.96), including young patients with no comorbidities (P<0.001). Compared to those with a CDCS = 0, patients were more likely to be treated with RN if they had a CDCS>1 (odds ratios = 2.049, 95% CI: 1.527-2.750). CONCLUSIONS: Young patients treated with PN demonstrate an overall survival advantage. This survival advantage is observed after an early follow-up even in those without comorbidities. It is still not clear if the survival advantage seen is due to treatment itself or selection bias.
Authors: Andrew W Silagy; Alejandro Sanchez; Brandon J Manley; Karim Bensalah; Axel Bex; Jose A Karam; Börje Ljungberg; Brian Shuch; A Ari Hakimi Journal: Eur Urol Focus Date: 2019-04-28
Authors: Wei Shen Tan; Sebastian Berg; Alexander P Cole; Marieke Krimphove; Maya Marchese; Stuart R Lipsitz; Junaid Nabi; Jesse D Sammon; Toni K Choueiri; Adam S Kibel; Maxine Sun; Steven Chang; Quoc-Dien Trinh Journal: JNCI Cancer Spectr Date: 2019-02-01