Comparison of survival rates in stage 1 renal cell carcinoma between partial nephrectomy and radical nephrectomy patients according to age distribution: a propensity score matching study Toshio Takagi, Tsunenori Kondo, Junpei Iizuka, Kenji Omae, Hirohito Kobayashi, Kazuhiko Yoshida, Yasunobu Hashimoto and Kazunari Tanabe Department of Urology, Tokyo Women’s Medical University, Tokyo, Japan
Objective
Results
To assess differences in overall survival (OS) between patients receiving partial nephrectomy (PN) and radical nephrectomy (RN) for stage 1 renal cell carcinoma (RCC) according to age distribution, as the survival advantage of PN vs RN has been unclear owing to conflicting data.
Group 1 included 66 matched patients; Group 2, 72; and Group 3, 70. Group 1 tended to have higher preoperative eGFR values and lower rates of HT and DM compared with Groups 2 and 3. Postoperative eGFR dropped by 11–13% in PN patients and by 34–36% in RN patients. In Group 3, PN patients had longer OS than RN patients (5-year OS: PN 96%, RN 81%, P = 0.043); however, there was no significant difference in Group 1 (5-year OS: PN 100%, RN 93%, P = 0.302) or Group 2 (5-year OS: PN 94%, RN 87%, P = 0.358).
Patients and Methods We studied 952 patients with stage 1 RCC who underwent either PN or RN. Patients were divided into three groups according to age: Group 1 (≤54 years), Group 2 (55– 64 years), and Group 3 (≥65 years). Patient variables including age, body mass index, sex, presence of hypertension (HT) and/or diabetes mellitus (DM), performance status, tumour size, pathological diagnosis, nuclear grade, and preoperative estimated glomerular filtration rate (eGFR), were adjusted using 1:1 propensity score matching between PN and RN.
Introduction The purpose of partial nephrectomy (PN) is to preserve kidney function as much as possible in order to prevent cardiovascular events and prolong life expectancy. This is based on a previous report showing a close relationship between chronic kidney disease (CKD) and cardiovascular events [1], as well as retrospective studies analysing the rates of cardiovascular events after kidney surgery for renal tumours [2–10]. These studies showed that patients undergoing PN had lower rates of cardiovascular problems and better survival rates than those undergoing radical nephrectomy (RN) [2–10]. However, a randomised study could not confirm an advantage of PN over RN in either survival rates [11] or kidney function after surgery in the limited follow-up period [12]. That study did not completely dismiss the significance of PN, and alluded to its other
BJU Int 2016; 117: E52–E59 wileyonlinelibrary.com
Conclusions Only the oldest group of patients showed significantly better OS for PN compared with RN; however, we still recommend PN in young patients.
Keywords nephrectomy, kidney function, kidney disease, chronic
benefits including the prevention of overtreatment for benign kidney tumours if a malignancy is suspected and avoiding the development of end-stage renal disease (ESRD) in cases of de novo or metastatic kidney cancer in the contralateral kidney. However, these results indicate that not all patients with small renal tumours may receive the same benefit from PN. Although PN is an imperative treatment for patients with a solitary kidney or those at risk of ESRD after RN, there are few studies delineating the types of patients with small renal tumours who are likely to benefit more from PN rather than RN. A multinational database study [13] showed that young patients with RCC underwent nephron-sparing surgery more frequently than older ones, possibly because of lower stage tumours or surgeons electing to preserve future kidney function. However, whether PN is more beneficial in
© 2015 The Authors BJU International © 2015 BJU International | doi:10.1111/bju.13200 Published by John Wiley & Sons Ltd. www.bjui.org
Age distribution of survival rates in stage 1 RCC between PN and RN
younger patients than in older ones has not been determined. Thus, we compared the effects of PN and RN on the overall survival (OS) of patients with localised RCC (stage 1) in different age groups to determine which group achieves the greatest OS benefit from PN. Moreover, to minimise selection bias, we adjusted patient variables such as age, sex, preoperative complications, performance status (PS), preoperative kidney function, and pathological findings using 1:1 propensity score matching.
Patients and Methods An Institutional Review Board-approved retrospective review was conducted on consecutive patients who underwent PN or RN at our hospital. The cohort consisted of patients with stage 1 RCC who were treated with RN or PN between 1979 and 2013. Patients on dialysis at the time of surgery were excluded, leaving 952 patients eligible for our study. Patients were divided into three age groups of about the same size at the time of surgery: Group 1 (≤54 years), Group 2 (55–64 years) and Group 3 (≥65 years). The following variables were considered for each patient: age, body mass index (BMI), presence of hypertension (HT) or diabetes mellitus (DM), sex, Eastern Cooperative Oncology Group PS, tumour size, pathological diagnosis, nuclear grade, preoperative and postoperative estimated GFR (eGFR), and follow-up period. All measurements of eGFR were performed
Objective
Results
To assess differences in overall survival (OS) between patients receiving partial nephrectomy (PN) and radical nephrectomy (RN) for stage 1 renal cell carcinoma (RCC) according to age distribution, as the survival advantage of PN vs RN has been unclear owing to conflicting data.
Group 1 included 66 matched patients; Group 2, 72; and Group 3, 70. Group 1 tended to have higher preoperative eGFR values and lower rates of HT and DM compared with Groups 2 and 3. Postoperative eGFR dropped by 11–13% in PN patients and by 34–36% in RN patients. In Group 3, PN patients had longer OS than RN patients (5-year OS: PN 96%, RN 81%, P = 0.043); however, there was no significant difference in Group 1 (5-year OS: PN 100%, RN 93%, P = 0.302) or Group 2 (5-year OS: PN 94%, RN 87%, P = 0.358).
Patients and Methods We studied 952 patients with stage 1 RCC who underwent either PN or RN. Patients were divided into three groups according to age: Group 1 (≤54 years), Group 2 (55– 64 years), and Group 3 (≥65 years). Patient variables including age, body mass index, sex, presence of hypertension (HT) and/or diabetes mellitus (DM), performance status, tumour size, pathological diagnosis, nuclear grade, and preoperative estimated glomerular filtration rate (eGFR), were adjusted using 1:1 propensity score matching between PN and RN.
Introduction The purpose of partial nephrectomy (PN) is to preserve kidney function as much as possible in order to prevent cardiovascular events and prolong life expectancy. This is based on a previous report showing a close relationship between chronic kidney disease (CKD) and cardiovascular events [1], as well as retrospective studies analysing the rates of cardiovascular events after kidney surgery for renal tumours [2–10]. These studies showed that patients undergoing PN had lower rates of cardiovascular problems and better survival rates than those undergoing radical nephrectomy (RN) [2–10]. However, a randomised study could not confirm an advantage of PN over RN in either survival rates [11] or kidney function after surgery in the limited follow-up period [12]. That study did not completely dismiss the significance of PN, and alluded to its other
BJU Int 2016; 117: E52–E59 wileyonlinelibrary.com
Conclusions Only the oldest group of patients showed significantly better OS for PN compared with RN; however, we still recommend PN in young patients.
Keywords nephrectomy, kidney function, kidney disease, chronic
benefits including the prevention of overtreatment for benign kidney tumours if a malignancy is suspected and avoiding the development of end-stage renal disease (ESRD) in cases of de novo or metastatic kidney cancer in the contralateral kidney. However, these results indicate that not all patients with small renal tumours may receive the same benefit from PN. Although PN is an imperative treatment for patients with a solitary kidney or those at risk of ESRD after RN, there are few studies delineating the types of patients with small renal tumours who are likely to benefit more from PN rather than RN. A multinational database study [13] showed that young patients with RCC underwent nephron-sparing surgery more frequently than older ones, possibly because of lower stage tumours or surgeons electing to preserve future kidney function. However, whether PN is more beneficial in
© 2015 The Authors BJU International © 2015 BJU International | doi:10.1111/bju.13200 Published by John Wiley & Sons Ltd. www.bjui.org
Age distribution of survival rates in stage 1 RCC between PN and RN
younger patients than in older ones has not been determined. Thus, we compared the effects of PN and RN on the overall survival (OS) of patients with localised RCC (stage 1) in different age groups to determine which group achieves the greatest OS benefit from PN. Moreover, to minimise selection bias, we adjusted patient variables such as age, sex, preoperative complications, performance status (PS), preoperative kidney function, and pathological findings using 1:1 propensity score matching.
Patients and Methods An Institutional Review Board-approved retrospective review was conducted on consecutive patients who underwent PN or RN at our hospital. The cohort consisted of patients with stage 1 RCC who were treated with RN or PN between 1979 and 2013. Patients on dialysis at the time of surgery were excluded, leaving 952 patients eligible for our study. Patients were divided into three age groups of about the same size at the time of surgery: Group 1 (≤54 years), Group 2 (55–64 years) and Group 3 (≥65 years). The following variables were considered for each patient: age, body mass index (BMI), presence of hypertension (HT) or diabetes mellitus (DM), sex, Eastern Cooperative Oncology Group PS, tumour size, pathological diagnosis, nuclear grade, preoperative and postoperative estimated GFR (eGFR), and follow-up period. All measurements of eGFR were performed
