Complete Title: #EAU15 - Nephron-sparing surgery protects from chronic kidney disease relative to radical nephrectomy but does not impact on other-causes mortality: Long-term (more than 10 years) survival and functional outcomes in patients with a T1a-T1b renal mass - Session Highlights
MADRID, SPAIN (UroToday.com) - This group reported on the long-term survival and functional outcomes of nephron sparing surgery (NSS) vs radical nephrectomy (RN) controlling for clinical characteristics, comorbidities, and individual patient’s cardiovascular risk.
A multi-institutional collaboration among 5 European tertiary care centers allowed identification of 1 189 patients with clinical T1a-T1bN0M0 renal mass treated between 1988 and 2004. Six hundred seventy-eight patients underwent RN and 511 underwent NSS. All patients had normal eGFR ≥ 60ml/min/1.73m2, preoperatively. Primary outcomes were risk of other-cause mortality (OCM) and development of chronic kidney disease (CKD).
Median follow up period was 10 years (6-13 yrs). Median age was 61 years (51-68) and median clinical tumor size was 4 cm (3-5). The 5-year, 10-year, and 15-year CKD rates after surgery were 6.3%, 16.4%, and 42.3% for NSS vs 13.2%, 28.4%, and 48.9% for RN, respectively (HR 0.65 95%CI 0.49-0.85). At multivariate analysis, patients who underwent NSS showed a significantly lower risk of CKD compared to those who underwent RN. The 5-year, 10-year and 15-year OCM rates after surgery were 6.0%, 14.0%, and 26.6% for NSS vs 7.3%, 14.2%, and 22.5% for RN, respectively (HR 1.08 95%CI 0.80-1.46). At multivariate analysis, controlling for other variables, patients who underwent NSS showed similar risk of dying from OCM compared to those who underwent RN (HR 0.97 95%CI 0.67-1.40).
The group concluded that when considering long-term survival and functional outcomes in patients with clinical T1a-T1b masses with normal renal function, preoperatively, NSS protects against CKD but does not impact OCM.
Presented by Capitanio U.,1 Terrone C.,2 Antonelli A.,3 Minervini A.,4 Porpiglia F.,5 Di Domenico A.,2 Furlan M.,3 Di Trapani E.,1 Salonia A.,1 Carini M.,4 Simeone C.,3 Montorsi F.,1 and Bertini R.1 at the 30th Annual European Association of Urology (EAU) Congress - March 20 - 24, 2015 - IFEMA - Feria de Madrid - Madrid, Spain
1San Raffaele Scientific Institute, Dept. of Urology, Milan, 2University of Piemonte Orientale, Dept. of Urology, Novara, 3Universita' Degli Studi E Spedali Civili, Dept. of Urology, Brescia, 4Clinica Urologica I, Azienda Ospedaliera Universitaria Careggi, Dept. of Urology, Florence, 5San Luigi Hospital-Orbassano, Dept. of Urology, Turin
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Reported by Mohammed Haseebuddin, MD, medical writer for UroToday.com