MP64-06 RECURRENCE AND SURVIVAL AFTER PARTIAL VERSUS RADICAL NEPHRECTOMY FOR T1 RENAL MASS

Abstract

You have accessJournal of UrologyKidney Cancer: Localized V1 Apr 2014MP64-06 RECURRENCE AND SURVIVAL AFTER PARTIAL VERSUS RADICAL NEPHRECTOMY FOR T1 RENAL MASS Connor M. Forbes, Ricardo A. Rendon, Antonio Finelli, Anil Kapoor, Ronald B. Moore, Rodney H. Breau, Louis Lacombe, Jun Kawakami, Darrel E. Drachenberg, Stephen E. Pautler, Michael Jewett, Zhihui Liu, Simon Tanguay, and Peter C. Black Connor M. ForbesConnor M. Forbes More articles by this author , Ricardo A. RendonRicardo A. Rendon More articles by this author , Antonio FinelliAntonio Finelli More articles by this author , Anil KapoorAnil Kapoor More articles by this author , Ronald B. MooreRonald B. Moore More articles by this author , Rodney H. BreauRodney H. Breau More articles by this author , Louis LacombeLouis Lacombe More articles by this author , Jun KawakamiJun Kawakami More articles by this author , Darrel E. DrachenbergDarrel E. Drachenberg More articles by this author , Stephen E. PautlerStephen E. Pautler More articles by this author , Michael JewettMichael Jewett More articles by this author , Zhihui LiuZhihui Liu More articles by this author , Simon TanguaySimon Tanguay More articles by this author , and Peter C. BlackPeter C. Black More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1923AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Partial nephrectomy for early stage renal cancer preserves renal function better than radical nephrectomy and is generally considered oncologically sound. The Intergroup EORTC prospective randomized phase 3 trial comparing oncologic outcomes after partial versus radical nephrectomy, however, has cast some doubt on this premise. This study aims to elucidate outcomes in partial versus radical nephrectomy for early stage tumours in the Canadian population. METHODS From 1989-2013, 1065 patients with a first occurrence of a clinical T1 renal mass who underwent partial or radical nephrectomy were identified from the Canadian Kidney Cancer Information System (CKCis), a national database of 2927 renal cancer patients. Baseline clinical, surgical, and pathologic parameters were collected. Progression-free survival was compared between types of surgery using a Cox proportional hazards model, adjusted for age at diagnosis, gender, clinical T stage, and diagnosis year. RESULTS Inclusion criteria were met by 726 partial and 339 radical nephrectomy patients, with median follow-up of 2.7 and 3.8 years, respectively. Pre-operative characteristics, surgical parameters and pathologic findings were similar in both groups, although patients undergoing radical nephrectomy more commonly had T1b disease (46% vs 19%) (Table 1). Unadjusted Kaplan-Meier progression-free survival was lower in radical than partial nephrectomy (log rank test, p=0.04). However, in the multivariable analysis, time to progression did not differ between radical and partial nephrectomy (hazard ratio 1.63, p=0.12, 95% C.I. 0.88 – 3.0). CONCLUSIONS These results indicate that progression-free survival does not differ between radical and partial nephrectomy in patients with T1 renal masses. This suggests that the selection of surgical approach should be based on other factors, including technical feasibility, potential complications and preservation of renal function. Table 1. Patient, tumour, and surgery characteristics Parameter Sub-Parameter Partial Nephrectomy Radical Nephrectomy Number - 726 (68%) 339 (32%) Age - 59 60 Gender Male 458 (63%) 208 (61%) - Female 268 (37%) 131 (39%) Clinical T stage T1 57 (8%) 25 (7%) - T1a 521 (72%) 130 (38%) - T1b 123 (19%) 118 (46%) Pathological N-stage N0 119 (17%) 93 (27%) - N1 2 (0%) 6 (2%) - Nx 601 (83%) 239 (71%) Histology chromophobe 62 (9%) 30 (9%) - clear cell 472 (68%) 240 (74%) - papillary 133 (19%) 51 (16%) - renal cell carcinoma 1 (0%) 1 (0%) - other 26 (4%) 4 (1%) Grade 1 98 (15%) 31 (10%) - 2 358 (56%) 168 (55%) - 3 169 (26%) 84 (28%) - 4 17 (3%) 21 (7%) Margin Status negative 649 (93%) 318 (98%) - positive 48 (7%) 5 (2%) Surgery open 402 (56%) 76 (23%) - laparoscopic 277 (38%) 255 (77%) - robotic 40 (6%) 1 (0%) Duration of surgery (min) - 153 163 Blood loss (mL) - 303 193 © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e702-e703 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Connor M. Forbes More articles by this author Ricardo A. Rendon More articles by this author Antonio Finelli More articles by this author Anil Kapoor More articles by this author Ronald B. Moore More articles by this author Rodney H. Breau More articles by this author Louis Lacombe More articles by this author Jun Kawakami More articles by this author Darrel E. Drachenberg More articles by this author Stephen E. Pautler More articles by this author Michael Jewett More articles by this author Zhihui Liu More articles by this author Simon Tanguay More articles by this author Peter C. Black More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...