Comparison of outcomes in elective partial vs radical nephrectomy for clear cell renal cell carcinoma of 4-7 cm Journal Article
| Authors: | Dash, A.; Vickers, A. J.; Schachter, L. R.; Bach, A. M.; Snyder, M. E.; Russo, P. |
| Article Title: | Comparison of outcomes in elective partial vs radical nephrectomy for clear cell renal cell carcinoma of 4-7 cm |
| Abstract: | OBJECTIVE: To compare the outcomes of patients who had a elective partial nephrectomy (PN) or radical nephrectomy (RN) for clear cell renal cell carcinoma (RCC) of 4-7 cm. PATIENTS AND METHODS: From March 1998 to July 2004, 45 and 151 patients underwent PN and RN, respectively, for clear cell RCC. A multivariate Cox model was constructed for disease-free survival with adjustment for markers of disease severity, and a propensity-score approach used as a confirmatory analysis. RESULTS: In the PN and RN cohorts the treatment failed in one and 20 patients, respectively; the median follow-up was 21 months. The hazard ratio (95% confidence interval) for PN after adjusting for disease severity was 0.36 (0.05-2.82; P = 0.3). Using planned PN as a predictor (intent-to-treat analysis) the hazard ratio was 1.06 (0.32-3.53; P = 0.9). In the propensity-score model, planned PN was associated with a hazard ratio of 1.75 (0.50-6.14; P = 0.4). The serum creatinine level 3 months after surgery was significantly lower in patients who had PN, with a difference between the means of 0.36 (0.23-0.48; P < 0.001). CONCLUSIONS: Renal function was preserved after PN for 4-7 cm clear cell RCC tumours. When comparing the outcomes of PN and RN it is important to consider the intended operation as an independent variable. There was no clear evidence that PN was associated with worse cancer control, although a continued follow-up of this and other cohorts is warranted. © 2006 BJU International. |
| Keywords: | adult; cancer survival; controlled study; treatment outcome; disease-free survival; middle aged; cancer surgery; treatment failure; major clinical study; postoperative period; disease marker; comparative study; disease free survival; outcome assessment; follow up; biological marker; tumor volume; cohort analysis; creatinine; creatinine blood level; renal cell carcinoma; kidney carcinoma; kidney neoplasms; nephrectomy; confidence interval; disease severity; radical nephrectomy; carcinoma, renal cell; kidney function; scoring system; multivariate analysis; cancer control; elective surgery; clear cell adenocarcinoma; elective partial nephrectomy |
| Journal Title: | BJU International |
| Volume: | 97 |
| Issue: | 5 |
| ISSN: | 1464-4096 |
| Publisher: | Wiley Blackwell |
| Date Published: | 2006-05-01 |
| Start Page: | 939 |
| End Page: | 945 |
| Language: | English |
| DOI: | 10.1111/j.1464-410X.2006.06060.x |
| PUBMED: | 16643474 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 112" - "Export Date: 4 June 2012" - "CODEN: BJINF" - "Source: Scopus" |
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