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Radical nephrectomy for pT1a renal masses may be associated with decreased overall survival compared with partial
R Houston Thompson1, Stephen A Boorjian, Christine M Lohse
1Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota, USA.
Purpose:
We reviewed our surgical experience with small renal tumors, comparing overall survival in patients treated with radical and partial nephrectomy.
Materials And Methods:
Using our nephrectomy registry we identified patients with sporadic, unilateral, solitary and localized renal masses 4 cm or less who underwent radical or partial nephrectomy between 1989 and 2003. Patients with a solitary kidney or impaired renal function at presentation were excluded, leaving 648 available for analysis. Overall survival was estimated using the Kaplan-Meier method and associations with death were evaluated using Cox proportional hazards regression.
Results:
At last followup 146 patients had died of any cause and 502 were alive at a median of 7.1 years. Radical and partial nephrectomy was performed in 290 and 358 patients, respectively. In all patients radical nephrectomy was not significantly associated with death from any cause compared with partial nephrectomy (RR 1.12, p = 0.52). However, there was a significant interaction with age, leading us to stratify our analysis at the median age of 65 years. In 327 patients younger than 65 years radical nephrectomy was significantly associated with death from any cause compared with partial nephrectomy (RR 2.16, p = 0.02). The increased risk of death persisted after adjusting for year of surgery (p = 0.02), preoperative creatinine (p = 0.03), Charlson-Romano index (p = 0.04), symptoms at presentation (p = 0.02), diabetes at presentation (p = 0.03) and histology (p = 0.02).
Conclusions:
Our results suggest that, compared with partial nephrectomy, radical nephrectomy is associated with decreased overall survival in younger patients with small renal masses.
Insights
Radical nephrectomy for small renal masses is linked to lower survival in younger patients. Partial nephrectomy offers better overall survival for this demographic, highlighting age as a critical factor in treatment decisions.
Area of Science:
- Urology
- Nephrology
- Surgical Oncology
Background:
- Small renal masses (SRMs) are increasingly detected.
- Treatment options include radical nephrectomy (RN) and partial nephrectomy (PN).
- Comparative survival data for SRMs are crucial for clinical decision-making.
Purpose of the Study:
- To compare overall survival (OS) between radical nephrectomy and partial nephrectomy for small renal tumors.
- To investigate the impact of age on survival outcomes after nephrectomy for SRMs.
Main Methods:
- Retrospective analysis of 648 patients with SRMs (≤4 cm) undergoing RN or PN between 1989 and 2003.
- Kaplan-Meier method for OS estimation.
- Cox proportional hazards regression to identify predictors of mortality.
Main Results:
- No significant difference in OS between RN and PN for all patients.
- In patients younger than 65 years, RN was significantly associated with increased all-cause mortality (RR 2.16, p=0.02) compared to PN.
- This association persisted after adjusting for multiple clinical and demographic factors.
Conclusions:
- Radical nephrectomy is associated with decreased overall survival in younger patients with small renal masses.
- Partial nephrectomy may be a preferred surgical approach for younger patients with SRMs to improve long-term survival.
- Age is a significant factor influencing survival outcomes in patients treated for small renal masses.
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