Clinical efficacy of radical nephrectomy versus nephron-sparing surgery on localized renal cell carcinoma.

Wentao Li,Hui Ren,Yanlei Cheng,Yi Cheng,Na Han

doi:10.1186/s40001-014-0058-4

Abstract

BackgroundThe aim of the present study was to compare the clinical efficacy of radical nephrectomy (RN) with nephron-sparing surgery (NSS) in treating patients with localized renal cell carcinoma (RCC).MethodsThe literature search was performed in PubMed, MEDLINE Springer, Elsevier Science Direct, Cochrane Library, and Google Scholar up to December 2012. The software Review Manager 5.1 and the STATA software package v.11.0 were used for analyses. The odds ratios (ORs) and its 95% confidence interval (95% CI) were calculated for comparison. Subgroup analyses were performed based on the tumor size of RCC.ResultsIn total, 10 studies with 10,174 RCC patients (7,050 treated with RN and 3,124 treated with NSS) were selected. The pooled estimate (OR = 1.58, 95% CI = 1.15–2.15, P = 0.004) showed a significantly lower rate of cancer-specific deaths in the patients treated with NSS compared to RN. However, no statistically significant differences were found in the rate of tumor recurrence (OR = 0.84, 95% CI = 0.67–1.06, P = 0.14) and complications (OR = 0.91, 95% CI = 0.51–1.63, P = 0.74) between the patients treated with NSS and RN. In addition, all the subgroup analyses presented consistent results with the overall analyses.ConclusionsNSS had no significantly different from RN in tumor recurrence and complications for localized RCC. However, the significantly lower rate of cancer-specific deaths supported the use of NSS not only for RCC with tumor size >4.0 cm but also for tumor sizes ≤4.0 cm compared with RN.

Highlights

The aim of the present study was to compare the clinical efficacy of radical nephrectomy (RN) with nephron-sparing surgery (NSS) in treating patients with localized renal cell carcinoma (RCC)
Characteristics of included studies A total of 10 eligible studies [6,15,16,17,18,19,20,21,22,23] comprising 10,174 RCC patients (7,050 patients treated by RN and 3,124 patients treated by NSS) were included in the metaanalysis
The results showed that NSS had a significantly lower cancer-specific death rate compared with RN for RCC patients there was no significant difference in the rate of tumor recurrence and complications between the patients treated by NSS or RN

Summary

Introduction

The aim of the present study was to compare the clinical efficacy of radical nephrectomy (RN) with nephron-sparing surgery (NSS) in treating patients with localized renal cell carcinoma (RCC). Renal cell carcinoma (RCC) is the third most common malignancy of the genitourinary system characterized by lack of early warning signs, protean clinical manifestations, and resistance to radiotherapy and chemotherapy [1]. In spite of the rapid development of medical technology, RCC remains a difficult malignancy to treat because of its ability to spread asymptomatically and its inherent resistance to conventional chemotherapy [3]. Nephron-sparing surgery (NSS) has been increasingly advocated in recent years and has challenged this concept [7]. Whether NSS is a better treatment than RN for RCC still remains controversial. Another study showed that NSS seemed to be significantly less effective than RN in terms of overall survival in the intention-to-treat population [10]

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