Oncologic and Functional Outcomes after Partial Nephrectomy Versus Radical Nephrectomy in T1b Renal Cell Carcinoma: A Multicenter, Matched Case-Control Study in Korean Patients
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose The study was to compare the oncologic and functional outcomes of partial nephrectomy (PN) and radical nephrectomy (RN) for pathologically proven T1b renal cell carcinoma using pair-matched groups. Materials and Methods We reviewed our prospectively maintained database for RN and PN in T1b renal tumors surgically treated between 1999 and 2011 at five institutions in Korea. Of 611 patients treated with PN or RN for a solitary and NX/N0 M0 renal mass (4-7 cm), 577 (PN, 100; RN, 477) patients with pathologically confirmed pT1b remained for analysis. Study subjects were grouped by PN or RN, then matched by age, sex, comorbidities, body mass index, tumor size and depth, histologic type, and preoperative estimated glomerular filtration rate (eGFR) using propensities score. To evaluate oncologic outcomes, overall survival (OS), cancer- specific survival (CSS), and progression-free survival (PFS) rates were analyzed. The functional outcomes were evaluated by postoperative eGFR. Results The median follow-up in the RN group was 48.1 and 42.6 months in the PN group. The estimated 10-year CSS rate (PN 85.7% vs. RN 84.4%, p=0.52) and 5- and estimated 10-year PFS rates (PN: 86.4% and 79.2% vs. RN: 86.0% and 66.1%, p=0.66) did not differ significantly between groups. The estimated 10-year OS rate was significantly higher in the PN group (85.7%) compared to the RN group (73.3%) (p=0.003). PN was less likely to induce new-onset chronic kidney disease (CKD) and end-stage CKD compared with RN. Conclusion Our study suggests that patients treated with PN demonstrate a superior OS rate and postoperative renal function with analogous CSS and PFS rates compared with pair-matched patients treated with RN.
Abstract
Purpose The study was to compare the oncologic and functional outcomes of partial nephrectomy (PN) and radical nephrectomy (RN) for pathologically proven T1b renal cell carcinoma using pair-matched groups. Materials and Methods We reviewed our prospectively maintained database for RN and PN in T1b renal tumors surgically treated between 1999 and 2011 at five institutions in Korea. Of 611 patients treated with PN or RN for a solitary and NX/N0 M0 renal mass (4-7 cm), 577 (PN, 100; RN, 477) patients with pathologically confirmed pT1b remained for analysis. Study subjects were grouped by PN or RN, then matched by age, sex, comorbidities, body mass index, tumor size and depth, histologic type, and preoperative estimated glomerular filtration rate (eGFR) using propensities score. To evaluate oncologic outcomes, overall survival (OS), cancer- specific survival (CSS), and progression-free survival (PFS) rates were analyzed. The functional outcomes were evaluated by postoperative eGFR. Results The median follow-up in the RN group was 48.1 and 42.6 months in the PN group. The estimated 10-year CSS rate (PN 85.7% vs. RN 84.4%, p=0.52) and 5- and estimated 10-year PFS rates (PN: 86.4% and 79.2% vs. RN: 86.0% and 66.1%, p=0.66) did not differ significantly between groups. The estimated 10-year OS rate was significantly higher in the PN group (85.7%) compared to the RN group (73.3%) (p=0.003). PN was less likely to induce new-onset chronic kidney disease (CKD) and end-stage CKD compared with RN. Conclusion Our study suggests that patients treated with PN demonstrate a superior OS rate and postoperative renal function with analogous CSS and PFS rates compared with pair-matched patients treated with RN.
참고문헌 (25)
- Van Poppel H, "Incidental renal cell carcinoma and nephron sparing surgery", Curr Opin Urol, 11, pp.281~286 (2001)
- Lee CT, "Surgical management of renal tumors 4 cm or less in a contemporary cohort", J Urol, 163, pp.730~736 (2000)
- Clark PE, "Quality of life and psychological adaptation after surgical treatment for localized renal cell carcinoma : impact of the amount of remaining renal tissue", Urology, 57, pp.252~256 (2001)
- Patard JJ, "Morbidity and clinical outcome of nephron-sparing surgery in relation to tumour size and indication", Eur Urol, 52, pp.148~154 (2007)
- Thompson RH, "Partial versus radical nephrectomy for 4 to 7 cm renal cortical tumors", J Urol, 182, pp.2601~2606 (2009)
- Campbell SC, "Expanding the indications for elective partial nephrectomy : is this advisable?", Eur Urol, 49, pp.952~954 (2006)
- National Kidney Foundation, "K", DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification, 2002, pp.39(2 Suppl 1), 1~266
- Dindo D, "Classification of surgical complications : a new proposal with evaluation in a cohort of 6336 patients and results of a survey", Ann Surg, 240, pp.205~213 (2004)
- Cockcroft DW, "Prediction of creatinine clearance from serum creatinine", Nephron, 16, pp.31~41 (1976)
- Levey AS, "National Kidney Foundation practice guidelines for chronic kidney disease : evaluation, classification, and stratification", Ann Intern Med, 139, pp.137~147 (2003)
- Leibovich BC, "Nephron sparing surgery for appropriately selected renal cell carcinoma between 4 and 7 cm results in outcome similar to radical nephrectomy", J Urol, 171, pp.1066~1070 (2004)
- Badalato GM, "Survival after partial and radical nephrectomy for the treatment of stage T1bN0M0 renal cell carcinoma(RCC)in the USA : a propensity scoring approach", BJU Int, 109, pp.1457~1462 (2012)
- Weight CJ, "Partial nephrectomy is associated with improved overall survival compared to radical nephrectomy in patients with unanticipated benign renal tumours", Eur Urol, 58, pp.293~298 (2010)
- Iizuka J, "Similar functional outcomes after partial nephrectomy for clinical T1b and T1a renal cell carcinoma", Int J Urol, 19, pp.980~986 (2012)
- Kim SP, "Comparative effectiveness for survival and renal function of partial and radical nephrectomy for localized renal tumors: a systematic review and meta-analysis", J Urol (2012)[DOI]
- Van Poppel H, "A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma", Eur Urol, 59, pp.543~552 (2011)
- Kletscher BA, "Prospective analysis of multifocality in renal cell carcinoma : influence of histological pattern, grade, number, size, volume and deoxyribonucleic acid ploidy", J Urol, 153(3 Pt 2), pp.904~906 (1995)
- Kobayashi M, "Nephron-sparing surgery is still controversial for patients with renal cell carcinoma and normal contralateral kidney : risks predictable by AgNOR counts in satellite lesions", Mol Urol, 4, pp.21~29 (2000)
- Roos FC, "Oncologic long-term outcome of elective nephronsparing surgery versus radical nephrectomy in patients with renal cell carcinoma stage pT1b or greater in a matched-pair cohort", Urology, 77, pp.803~808 (2011)
- Lane BR, "10-year oncologic outcomes after laparoscopic and open partial nephrectomy", J Urol, 190, pp.44~49 (2013)
- Hafez KS, "Nephron sparing surgery for localized renal cell carcinoma : impact of tumor size on patient survival, tumor recurrence and TNM staging", J Urol, 162, pp.1930~1933 (1999)
- Thompson RH, "Complications of contemporary open nephron sparing surgery : a single institution experience", J Urol, 174, pp.855~858 (2005)
- Gill IS, "Comparative analysis of laparoscopic versus open partial nephrectomy for renal tumors in 200 patients", J Urol, 170, pp.64~68 (2003)
- Papalia R, "Laparoscopic and robotic partial nephrectomy without renal ischaemia for tumours larger than 4 cm : perioperative and functional outcomes", World J Urol, 30, pp.671~676 (2012)
- Yossepowitch O, "Positive surgical margins at partial nephrectomy : predictors and oncological outcomes", J Urol, 179, pp.2158~2163 (2008)