Nephron-sparing Surgery Is Equally Effective to Radical Nephrectomy for T1BN0M0 Renal Cell Carcinoma: A Population-based Assessment - 20/08/11

Doi : 10.1016/j.urology.2009.04.098

Maxime Crépel ^a,^b, Claudio Jeldres ^a,^c, Paul Perrotte ^c, Umberto Capitanio ^a,^d, Hendrik Isbarn ^a,^e, Shahrokh F. Shariat ^f, Daniel Liberman ^a, Maxine Sun ^a, Giovanni Lughezzani ^a,^d, Philippe Arjane ^a,^d, Hugues Widmer ^c, Markus Graefen ^e, Francesco Montorsi ^c, Jean-Jacques Patard ^b, Pierre I. Karakiewicz ^a,^c,^⁎
^a Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, Quebec, Canada
^b Rennes University Hospital, Rennes, France
^c Department of Urology, University of Montreal, Montreal, Canada
^d Department of Urology, Vita-Salute San Raffaele, Milan, Italy
^e Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
^f Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York

Reprint requests: Pierre I. Karakiewicz, M.D., F.R.C.S.C., Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center (CHUM), 1058, rue St-Denis, Montréal, Québec H2X 3J4, Canada

Résumé

Objectives

To test the effect of nephron-sparing surgery (NSS) vs radical nephrectomy (RN) on cancer-specific mortality (CSM) in patients with T1bN0M0 renal cell carcinoma (RCC) in a population-based cohort. To date, only few series from tertiary care centers supported the use of NSS for T1bN0M0 (range 4-7 cm) RCC.

Methods

The Surveillance, Epidemiology, and End Results database allowed us to identify 275 NSS (5.3%) and 4866 RN (94.7%) patients treated for T1bN0M0 RCC between 1988 and 2004. Analyses matched for age, year of surgery, tumor size, and Fuhrman grade addressed the effect of nephrectomy type (NSS vs RN) on CSM.

Results

Five years after surgery, the surviving proportions of NSS and RN patients matched for age, tumor size, and year of surgery were respectively 91.4 and 95.3% and 90.1 and 93.8% in the cohort, where additional matching for Fuhrman grade was performed. Neither of the matched analyses resulted in statistically significant CSM difference (P = .1 and .4) between NSS and RN. Similarly, competing-risks regression analyses based on both matching schemes also failed to reveal statistically significant CSM differences (P = .3 and .3).

Conclusions

Our study represents the largest and the only population-based analysis of cancer control efficacy of NSS vs RN in T1bN0M0 RCC. It indicates that NSS does provide equivalent cancer control relative to RN. In consequence, based on cancer control equivalence, NSS should be given equal consideration to RN in patients with T1bN0M0 lesions.

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Plan

Material and Methods

Statistical Analyses

Results

Effect of NSS vs RN on Freedom From CSM in Cox Regression Models

Effect of NSS Versus RN on Freedom From CSM in Competing-Risks Regression Models

Comment

Conclusions

	Pierre I. Karakiewicz is partially supported by the University of Montreal Health Center Urology Associates, Fonds de la Recherche en santé du Quebec, the University of Montreal Department of Surgery and the University of Montreal Health Center (CHUM) Foundation.
	Maxime Crépel is partially supported by the Association Française d'urologie.