1075 IMPROVED FUNCTIONAL OUTCOMES WITH SIMILAR CANCER OUTCOMES IN PATIENTS WITH HIGH RISK LOCALIZED RENAL CELL CARCINOMA TREATED WITH PARTIAL AS COMPARED TO RADICAL NEPHRECTOMY

Abstract

You have accessJournal of UrologyKidney Cancer: Localized1 Apr 20111075 IMPROVED FUNCTIONAL OUTCOMES WITH SIMILAR CANCER OUTCOMES IN PATIENTS WITH HIGH RISK LOCALIZED RENAL CELL CARCINOMA TREATED WITH PARTIAL AS COMPARED TO RADICAL NEPHRECTOMY Rebecca L. O'Malley, MD Matthew H. Hayn, MD Hyung L. Kim, MD Katherine A. Brewer, Michael A. Poch, andMD Thomas SchwaabMD, PhD Rebecca L. O'MalleyRebecca L. O'Malley Buffalo, NY More articles by this author , Matthew H. HaynMatthew H. Hayn Buffalo, NY More articles by this author , Hyung L. KimHyung L. Kim Los Angeles, CA More articles by this author , Katherine A. BrewerKatherine A. Brewer Buffalo, NY More articles by this author , Michael A. PochMichael A. Poch Buffalo, NY More articles by this author , and Thomas SchwaabThomas Schwaab Buffalo, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1113AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Cancer outcomes are similar for radical (RN) and partial nephrectomy (PN) for low-stage renal cell carcinoma (RCC). However, when pathologic analysis reveals disease at high risk for recurrence, i.e. stage ≥pT3 or grade ≥3, outcomes are unclear. We undertook this analysis to investigate survival and renal function outcomes of PN and RN in pts with high risk disease (HRD). METHODS From our institutional renal tumor database, we identified pts with a localized, solitary tumor ≤ 7 cm in size, who underwent PN or RN, from June 1997 to September 2010. Those with HRD were those with pathologic stage ≥pT3 or grade ≥3. Survival and renal functional outcomes were compared between those with HRD who underwent PN and those who underwent RN. RESULTS Of the 326 pts fitting inclusion criteria, 118 pts (36.1%) had HRD, 62 and 56 of which underwent RN and PN, respectively. Mean age, race distribution, smoking history, Eastern Cooperative Oncology Group performance status, and mean body mass index were similar between the PN and RN groups. Charlson comorbidity index (CCI) of >1 was seen in 52% of the PN group and 45% of the RN group (p=0.720). Pre-operative tumor size was larger in the RN group (5.1 vs. 3.6 cm, p<0.001). Rates of positive surgical margins and of non-clear cell histology were similar. Mean glomerular filtration rates (eGFR), as estimated by the Chronic Kidney Disease Epidemiology Collaboration formula and pre-operative rates of stage 3 chronic kidney disease (CKD) in the PN group were 75 ml/min/1.73m2 and 23% vs. 71 ml/min/1.73m2 and 27% in the RN group (p=0.352 and p=0.600, respectively). Post-operatively, the PN group had a lower mean decrease in eGFR (8 vs. 22 ml/min/1.73m2, p<0.001) and lower rate of development of stage 3 CKD (13 vs. 26%, p<0.001). At a mean follow-up was 30 months, 2-year overall survival (OS) tended to be worse in the RN group (Figure) but this did not reach statistical significance (86 vs 97%, p=0.224). OS was predicted only by high CCI (HR 10.5, p<0.001). At 2 years, recurrence-free survival was similar between the PN and RN groups (100 and 93%, p=0.556). CONCLUSIONS Intermediate term survival outcomes of those with high risk, localized RCC are similar if treated by RN or PN. PN is the preferred treatment due to superior renal function outcomes. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e432 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rebecca L. O'Malley Buffalo, NY More articles by this author Matthew H. Hayn Buffalo, NY More articles by this author Hyung L. Kim Los Angeles, CA More articles by this author Katherine A. Brewer Buffalo, NY More articles by this author Michael A. Poch Buffalo, NY More articles by this author Thomas Schwaab Buffalo, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...