Partial Nephrectomy for T2 Renal Masses: Contemporary Trends and Oncologic Efficacy

Overview

Journal Int Urol Nephrol

Publisher Springer

Specialty Nephrology

Date 2015 Apr 13

PMID 25864101

Citations 12

Authors

Shaheen Alanee

Max Nutt

Aaron Moore

Bradley Holland

Danuta Dynda

Andrew Wilber

Ahmed El-Zawahry

Affiliations

Soon will be listed here.

Abstract

Purpose: Increasing popularity and improved technical feasibility of partial nephrectomy (PN) has encouraged urologists to treat larger renal masses with nephron-sparing surgery. We used a national database to characterize practice patterns for the surgical management of patients with T2 renal tumors and examined the effect of PN on cancer-specific survival in such patients.

Methods: Between 2001 and 2011, 10,259 patients with primary tumor size >7 cm confined to the kidney (T2) were treated surgically for kidney cancer. PN trends were examined using annual percentage change (APC). Multivariate survival models were developed to identify independent determinants of PN use and cancer-specific survival (CSS) following surgical treatment of kidney cancer.

Results: Overall, 543 patients (5.29 %) were treated with PN versus 9716 (94.71 %) who underwent radical nephrectomy (RN). The use of PN increased progressively between 2001 and 2011 (APC +11.1 %, p < 0.05). Male gender, geographic location, year of diagnosis, and disease stage were independent determinants of increased PN use (all p values <0.05). Cancer-specific mortality was not inferior for patients treated with PN versus RN (HR 0.68, 95 % CI 0.50-0.94). Male gender, younger age, white race, tumor size >10 cm, localized disease, and papillary histology were all associated with improved CSS with PN (all p values <0.05).

Conclusions: PN is increasingly utilized to treat T2 renal masses. Our analysis demonstrates that PN for T2 renal masses has no contraindicated effect on CSS.

Citing Articles

Tracing the evolving dynamics and research hotspots in the kidney neoplasm and nephron sparing surgery field from the past to the new era.

Yao Y, Liu Y, Yang T, Lu B, Yang X, Zhang H Cancer Med. 2024; 13(12):e7336.

PMID: 39651783 PMC: 11192648. DOI: 10.1002/cam4.7336.

The application of mixed reality navigation system in laparoscopic partial nephrectomy for highly complex renal tumors (RENAL score ≥10): a retrospective cohort study.

Liu W, Wang Y, Wang Z, Cao Z, Yu Y, Wang J Int J Surg. 2024; 111(1):1513-1516.

PMID: 39093872 PMC: 11745591. DOI: 10.1097/JS9.0000000000001983.

Time trends in surgical provision and cancer-specific outcomes in patients with stage T2-3 kidney cancer: a SEER-based study.

Song Z, Xing J, Sun Z, Kang X, Li H, Ren G Front Surg. 2024; 11:1370702.

PMID: 38742149 PMC: 11089187. DOI: 10.3389/fsurg.2024.1370702.

Patient Factors Impacting Perioperative Outcomes for T1b-T2 Localized Renal Cell Carcinoma May Guide Decision for Partial versus Radical Nephrectomy.

Shah Y, Simhal R, Wang K, Goldberg H, Lallas C, Chandrasekar T J Clin Med. 2023; 12(1).

PMID: 36614976 PMC: 9821707. DOI: 10.3390/jcm12010175.

Histopathological validation of safe margin for nephron-sparing surgery based on individual tumor growth pattern.

Li G, Xiao T, Wang K, Zhang R, Wang A, Yan C World J Surg Oncol. 2021; 19(1):255.

PMID: 34454535 PMC: 8403410. DOI: 10.1186/s12957-021-02375-3.

References

Taub D, Miller D, Cowan J, Dimick J, Montie J, Wei J . Impact of surgical volume on mortality and length of stay after nephrectomy. Urology. 2004; 63(5):862-7. DOI: 10.1016/j.urology.2003.11.037. View

Huang W, Elkin E, Levey A, Jang T, Russo P . Partial nephrectomy versus radical nephrectomy in patients with small renal tumors--is there a difference in mortality and cardiovascular outcomes?. J Urol. 2008; 181(1):55-61. PMC: 2748741. DOI: 10.1016/j.juro.2008.09.017. View

van Poppel H, Da Pozzo L, Albrecht W, Matveev V, Bono A, Borkowski A . A prospective randomized EORTC intergroup phase 3 study comparing the complications of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol. 2006; 51(6):1606-15. DOI: 10.1016/j.eururo.2006.11.013. View

Derose S, Rutkowski M, Crooks P, Shi J, Wang J, Kalantar-Zadeh K . Racial differences in estimated GFR decline, ESRD, and mortality in an integrated health system. Am J Kidney Dis. 2013; 62(2):236-44. PMC: 3723721. DOI: 10.1053/j.ajkd.2013.01.019. View

Miller D, Hollingsworth J, Hafez K, Daignault S, Hollenbeck B . Partial nephrectomy for small renal masses: an emerging quality of care concern?. J Urol. 2006; 175(3 Pt 1):853-7. DOI: 10.1016/S0022-5347(05)00422-2. View

Long C, Canter D, Kutikov A, Li T, Simhan J, Smaldone M . Partial nephrectomy for renal masses ≥ 7 cm: technical, oncological and functional outcomes. BJU Int. 2012; 109(10):1450-6. DOI: 10.1111/j.1464-410X.2011.10608.x. View

Garg T, Pinheiro L, Atoria C, Donat S, Weissman J, Herr H . Gender disparities in hematuria evaluation and bladder cancer diagnosis: a population based analysis. J Urol. 2014; 192(4):1072-7. PMC: 4260395. DOI: 10.1016/j.juro.2014.04.101. View

Patel H, Kates M, Pierorazio P, Allaf M . Race and sex disparities in the treatment of older patients with T1a renal cell carcinoma: a comorbidity-controlled competing-risks model. Urol Oncol. 2014; 32(5):576-83. PMC: 4062588. DOI: 10.1016/j.urolonc.2014.01.002. View

Karellas M, OBrien M, Jang T, Bernstein M, Russo P . Partial nephrectomy for selected renal cortical tumours of ≥ 7 cm. BJU Int. 2010; 106(10):1484-7. PMC: 4319322. DOI: 10.1111/j.1464-410X.2010.09405.x. View

10.

Kopp R, Mehrazin R, Palazzi K, Liss M, Jabaji R, Mirheydar H . Survival outcomes after radical and partial nephrectomy for clinical T2 renal tumours categorised by R.E.N.A.L. nephrometry score. BJU Int. 2013; 114(5):708-18. DOI: 10.1111/bju.12580. View

11.

Tuttle K, Bakris G, Bilous R, Chiang J, de Boer I, Goldstein-Fuchs J . Diabetic kidney disease: a report from an ADA Consensus Conference. Am J Kidney Dis. 2014; 64(4):510-33. DOI: 10.1053/j.ajkd.2014.08.001. View

12.

Hollenbeck B, Taub D, Miller D, Dunn R, Wei J . Use of nephrectomy at select medical centers--a case of follow the crowd?. J Urol. 2006; 175(2):670-4. DOI: 10.1016/S0022-5347(05)00146-1. View

13.

Campbell S, Novick A, Belldegrun A, Blute M, Chow G, Derweesh I . Guideline for management of the clinical T1 renal mass. J Urol. 2009; 182(4):1271-9. DOI: 10.1016/j.juro.2009.07.004. View

14.

Steffens S, Janssen M, Roos F, Becker F, Schumacher S, Seidel C . Incidence and long-term prognosis of papillary compared to clear cell renal cell carcinoma--a multicentre study. Eur J Cancer. 2012; 48(15):2347-52. DOI: 10.1016/j.ejca.2012.05.002. View

15.

Clark A, Breau R, Morash C, Fergusson D, Doucette S, Cagiannos I . Preservation of renal function following partial or radical nephrectomy using 24-hour creatinine clearance. Eur Urol. 2008; 54(1):143-49. DOI: 10.1016/j.eururo.2008.03.037. View

16.

Huang W, Levey A, Serio A, Snyder M, Vickers A, Raj G . Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lancet Oncol. 2006; 7(9):735-40. PMC: 2239298. DOI: 10.1016/S1470-2045(06)70803-8. View

17.

Hankey B, Ries L, Edwards B . The surveillance, epidemiology, and end results program: a national resource. Cancer Epidemiol Biomarkers Prev. 1999; 8(12):1117-21. View

18.

McKiernan J, Simmons R, Katz J, Russo P . Natural history of chronic renal insufficiency after partial and radical nephrectomy. Urology. 2002; 59(6):816-20. DOI: 10.1016/s0090-4295(02)01501-7. View

19.

Lau W, Blute M, Weaver A, Torres V, Zincke H . Matched comparison of radical nephrectomy vs nephron-sparing surgery in patients with unilateral renal cell carcinoma and a normal contralateral kidney. Mayo Clin Proc. 2000; 75(12):1236-42. DOI: 10.4065/75.12.1236. View

20.

Li J, Weir H, Jim M, King S, Wilson R, Master V . Kidney cancer incidence and mortality among American Indians and Alaska Natives in the United States, 1990-2009. Am J Public Health. 2014; 104 Suppl 3:S396-403. PMC: 4035892. DOI: 10.2105/AJPH.2013.301616. View