1640 COMPARED TO RADICAL NEPHRECTOMY, NEPHRON-SPARING SURGERY OFFERS A LONG-TERM SURVIVAL ADVANTAGE IN PATIENTS BETWEEN THE AGES OF 20 AND 44 WITH RENAL CELL CARCINOMAS (Â 4CM): AN ANALYSIS OF THE SEER DATABASE

Abstract

You have accessJournal of UrologyKidney Cancer: Localized (IV)1 Apr 20131640 COMPARED TO RADICAL NEPHRECTOMY, NEPHRON-SPARING SURGERY OFFERS A LONG-TERM SURVIVAL ADVANTAGE IN PATIENTS BETWEEN THE AGES OF 20 AND 44 WITH RENAL CELL CARCINOMAS (Â 4CM): AN ANALYSIS OF THE SEER DATABASE Michael Daugherty and Gennady Bratslavsky Michael DaughertyMichael Daugherty Syracuse, NY More articles by this author and Gennady BratslavskyGennady Bratslavsky Syracuse, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.3106AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Partial Nephrectomy (PN) decreases the risk of developing chronic kidney disease as opposed to Radical Nephrectomy (RN). While prior studies have demonstrated the survival advantage of PN in older patients (>65 years old), they have been criticized by selection bias in procedure selection due to comorbidities. We hypothesized that the long-standing effects of renal preservation would manifest in a survival advantage of a younger patient population, where selection bias of procedure due to comorbidities is minimized. METHODS The SEER 18-registries database was queried for patients age 20-44 surgically treated between 1993 and 2003 for RCC Â4cm with known grade and histology. Patients with prior RCC, multiple tumors, metastatic or locally advanced disease were excluded. The final cohort consisted of 222 subjects treated with PN and 494 subjects treated with RN. Chi-square and LogRank Kaplan-Meier analyses were used to compare patient and tumor characteristics and patient survival, respectively. RESULTS There were no differences between patients treated by PN or RN in demographics or tumor characteristics. Additionally, there was no difference in cancer-specific survival between the two groups (PN vs. RN) at 5 or 10 years (100% vs. 99.6% (p=0.34), and 100% vs. 98.3% (p=0.1), respectively). While there was no difference in 5-year overall survival (98.2% vs. 95.5%, p=0.07), the patients treated with PN had an advantage in 10-year overall survival compared to patients treated with RN (94% vs. 89.7%, p=0.025). CONCLUSIONS Present SEER analyses demonstrate that when compared to radical nephrectomy, nephron-sparing surgery results in improved overall survival in patients treated for localized small renal cell carcinoma. As expected, the survival advantage is observed late, and supports the importance of long-term renal functional preservation. The present study of a younger patient population allows for minimizing selection bias in choosing surgical procedure due to comorbidities, and provides further support for maximal renal preservation in patients with a life expectancy of 10 years or more. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e674-e675 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Daugherty Syracuse, NY More articles by this author Gennady Bratslavsky Syracuse, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...