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Multicenter Study
. 2018 Mar;28(3):146-155.
doi: 10.1016/j.purol.2017.12.004. Epub 2018 Jan 11.

Overall survival and oncological outcomes after partial nephrectomy and radical nephrectomy for cT2a renal tumors: A collaborative international study from the French kidney cancer research network UroCCR

B Reix  1 , J-C Bernhard  2 , J-J Patard  3 , P Bigot  4 , A Villers  5 , E Suer  6 , N S Vuong  2 , G Verhoest  7 , Q Alimi  7 , J-B Beauval  8 , T Benoit  8 , F-X Nouhaud  9 , C Lenormand  9 , N Hamidi  6 , J Cai  10 , M Eto  11 , S Larre  12 , A El Bakhri  12 , G Ploussard  13 , A Hung  10 , N Koutlidis  14 , A Schneider  14 , J Carrouget  4 , S Droupy  15 , S Marchal  15 , A Doerfler  16 , S Seddik  16 , T Matsugasumi  10 , X Orsoni  17 , A Descazeaud  17 , C Pfister  9 , K Bensalah  7 , M Soulie  8 , I Gill  10 , V Flamand  5 ; Kidney Cancer group of the CCAFU  18
Affiliations
Multicenter Study

Overall survival and oncological outcomes after partial nephrectomy and radical nephrectomy for cT2a renal tumors: A collaborative international study from the French kidney cancer research network UroCCR

B Reix et al. Prog Urol. 2018 Mar.

Abstract
in English, French

Background: Partial nephrectomy (PN) is recommended as first-line treatment for cT1 stage kidney tumors because of a better renal function and probably a better overall survival than radical nephrectomy (RN). For larger tumors, PN has a controversial position due to lack of evidence showing good cancer control. The aim of this study was to compare the results of PN and RN in cT2a stage on overall survival and oncological results.

Method: A retrospective international multicenter study was conducted in the frame of the French kidney cancer research network (UroCCR). We considered all patients aged≥18 years who underwent surgical treatment for localized renal cell carcinoma (RCC) stage cT2a (7.1-10cm) between 2000 and 2014. Cox and Fine-Gray models were performed to analyze overall survival (OS), cancer specific survival (CSS) and cancer-free survival (CFS). Comparison between PN and RN was realized after an adjustment by propensity score considering predefined confounding factors: age, sex, tumor size, pT stage of the TNM classification, histological type, ISUP grade, ASA score.

Results: A total of 267 patients were included. OS at 3 and 5 years was 93.6% and 78.7% after PN and 88.0% and 76.2% after RN, respectively. CSS at 3 and 5 years was 95.4% and 80.2% after PN and 91.0% and 85.0% after RN. No significant difference between groups was found after propensity score adjustment for OS (HR 0.87, 95% CI: 0.37-2.05, P=0.75), CSS (HR 0.52, 95% CI: 0.18-1.54, P=0.24) and CFS (HR 1.02, 95% CI: 0.50-2.09, P=0.96).

Conclusion: PN seems equivalent to RN for OS, CSS and CFS in cT2a stage kidney tumors. The risk of recurrence is probably more related to prognostic factors than the surgical technique. The decision to perform a PN should depend on technical feasibility rather than tumor size, both to imperative and elective situation.

Level of evidence: 4.

Contexte. –: La néphrectomie partielle (NP) est recommandée en première intention pour les tumeurs du rein de stades cT1. Sa place est débattue pour les stades cT2 en raison du manque de preuve d’un bon contrôle carcinologique. L’objectif de cette étude était de comparer les résultats de la NP et de la néphrectomie élargie (NE) dans les stades cT2a sur la survie globale et les résultats oncologiques.

Méthode. –: Une étude rétrospective multicentrique internationale était menée à partir de bases de données de 15 centres. Tous les patients d’âge ≥ 18 ans ayant bénéficié d’un traitement chirurgical pour un CCR localisé de stade cT2a (7,1–10 cm) entre 2000 et 2014 étaient inclus. La comparaison entre NP et NE était effectuée après ajustement par score ASA et par score de propension tenant compte des facteurs de confusion prédéfinis : âge, sexe, taille tumorale, stade pT de la classification TNM, type histologique, grade ISUP.

Résultats. –: Au total, 267 patients étaient inclus. La survie globale (SG) à 3 et 5 ans était de 93,6 % et 78,7 % dans le groupe NP et de 88,0 % et 76,2 % dans le groupe NE. La survie spécifique (SSp) à 3 et 5 ans était de 95,4 % et 80,2 % dans le groupe NP et de 91,0 % et 85,0 % dans le groupe NE. Aucune différence significative entre les deux groupes n’était retrouvée après ajustement sur le score de propension pour la SG (HR 0,87, IC 0,37–2,05, p = 0,75), la SSp (HR 0,52, IC 0,18–1,54, p = 0,24) et la Survie sans récidive (SSR) (HR 1,02, IC 0,50–2,09, p = 0,96).

Conclusion. –: Les résultats de la NP semblent équivalents à la NE pour la SG, la SSp et la SSR. Le risque de récidive semble davantage lié aux facteurs pronostiques qu’à la technique chirurgicale. La décision de NP devrait dépendre de sa faisabilité technique plutôt que de la taille tumorale, aussi bien en situation élective qu’impérative.

Niveau de preuve.–: 4.

Keywords: Cancer du rein; Néphrectomie partielle; Oncology; Outcomes; Partial nephrectomy; Renal cancer; Résultats oncologiques; Sparing surgery; Survie globale.

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Conflict of interest statement

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Figures

Figure 1.
Figure 1.
Overall survival. A. Partial nephrectomy (PN) vs radical nephrectomy (RN). B. Elective partial nephrectomy (ePN) vs imperative partial nephrectomy (iPN) vs radical nephrectomy (RN).
Figure 2.
Figure 2.
Cancer specific survival. A. Partial nephrectomy (PN) vs radical nephrectomy (RN). B. Elective partial nephrectomy (ePN) vs imperative partial nephrectomy (iPN) vs radical nephrectomy (RN).
Figure 3.
Figure 3.
Cancer free survival. A. Partial nephrectomy (PN) vs radical nephrectomy (RN). B. Elective partial nephrectomy (ePN) vs imperative partial nephrectomy (iPN) vs radical nephrectomy (RN).
See this image and copyright information in PMC

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References

    1. Chow WH, Devesa SS, Warren JL, Fraumeni JF. Rising incidence of renal cell cancer in the United States. JAMA 1999;281(17):1628–31. - PubMed
    1. Hollingsworth JM, Miller DC, Daignault S, Hollenbeck BK. Rising incidence of small renal masses: a need to reassess treatment effect. J Natl Cancer Inst 2006;98(18):1331–4. - PubMed
    1. Hollingsworth JM, Miller DC, Daignault S, Hollenbeck BK. Five-year survival after surgical treatment for kidney cancer: a population-based competing risk analysis. Cancer 2007;109(9):1763–8. - PubMed
    1. Astor BC, Hallan SI, Miller ER, Yeung E, Coresh J. Glomerular filtration rate, albuminuria, and risk of cardiovascular and all-cause mortality in the US population. Am J Epidemiol 2008;167(10):1226–34. - PubMed
    1. Huang WC, Levey AS, Serio AM, Snyder M, Vickers AJ, Raj GV, et al. Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lancet Oncol 2006;7(9):735–40. - PMC - PubMed

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