PURPOSE: Compared with radical nephrectomy (RN), partial nephrectomy (PN) decreases the risk of developing chronic kidney disease.
Although numerous studies have demonstrated the survival advantage of PN in older patients, they have been criticized by selection bias toward the procedure owing to comorbidities. We hypothesized that long-standing effects of renal preservation would manifest in a survival advantage of a younger patient population, where selection bias owing to comorbidities is minimized.
MATERIALS AND METHODS: The Surveillance, Epidemiology, and End Results 18-registries database was queried for patients aged 20 to 44 years surgically treated between 1993 and 2003 for renal cell carcinoma (RCC)≤ 4cm with known grade and histology. Patients with prior RCC, multiple tumors, and metastatic or locally advanced disease were excluded. The final cohorts consisted of 222 and 494 subjects treated with PN and RN, respectively. The chi-square and log-rank analyses compared patient and tumor characteristics and patient survival, respectively.
RESULTS: There were no differences between the groups in demographics or tumor characteristics. Additionally, there was no difference in cancer-specific survival at 5 or 10 years (P = 0.34 and P = 0.1, respectively). Although there was no difference in 5-year overall survival (P = 0.07), PN offered an advantage in 10-year overall survival (P = 0.025).
CONCLUSIONS: Present Surveillance, Epidemiology, and End Results analyses demonstrate that compared with RN, PN improved overall survival in patients with small, localized RCC. As expected, the survival advantage is observed late and supports the importance of long-term renal functional preservation. Although our study is limited by lack of comorbidities, the results suggest that detrimental effects of RN may have implications on overall survival in younger patients with RCC.
Written by:
Daugherty M, Bratslavsky G. Are you the author?
Department of Urology, SUNY Upstate Medical University, Syracuse, NY.
Reference: Urol Oncol. 2014 Feb 1. pii: S1078-1439(13)00478-X.
doi: 10.1016/j.urolonc.2013.11.009
PubMed Abstract
PMID: 24495447
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