Korean J Urol.  2010 Sep;51(9):596-600.

Comparison of Partial and Radical Nephrectomy for pT1b Renal Cell Carcinoma

• Kim JM
• Song PH
• Kim HT
• Park TC

Abstract

PURPOSE
Partial nephrectomy (PN) for patients with T1a renal cell carcinoma (RCC) has increasingly become accepted, although its role for patients with T1b RCC remains controversial. We retrospectively evaluated and then compared the oncologic and functional outcomes of patients with pT1b RCC who were treated with PN or radical nephrectomy (RN).
MATERIALS AND METHODS
A total of 70 patients who were diagnosed with pT1bN0M0 RCC between January 1995 and December 2004 were included. The 5-year overall survival (OS), the 5-year recurrence-free survival (RFS), and the 5-year cancer-specific survival (CSS) were compared between the groups. Preoperative and postoperative serum creatinine and estimated glomerular filtration rate (GFR) levels were analyzed to assess renal function.
RESULTS
The 5-year OS (92.3% vs. 87.8%, p=0.501), RFS (92.3% vs. 77.8%, p=0.175), and CSS (92.3% vs. 94.5%, p=0.936) of the PN and RN groups were not statistically different. The proportion of patients with decreased renal function was lower in the PN group than in the RN group (PN=0% vs. RN=11.5%). The postoperative change in serum creatinine and the GFR 1 year after nephrectomy was higher in the RN group than in the PN group (PN=0.2+/-0.2, 12.1+/-9.1 vs. RN=0.3+/-0.5, 18.1+/-12.5), but there was no statistical difference.
CONCLUSIONS
There were no statistically significant differences in prognosis or renal function between patients treated with PN and those treated with RN for pT1b RCC. PN may be a useful treatment modality for patients with pT1b RCC.

Keyword

Nephrectomy; Prognosis; Renal cell carcinoma

MeSH Terms

Carcinoma, Renal Cell
Creatinine
Glomerular Filtration Rate
Humans
Nephrectomy
Prognosis
Retrospective Studies
Creatinine

Figure

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  FIG. 1 Kaplan-Meier survival curve estimates of the 5-year overall survival for all patients according to whether they underwent partial nephrectomy or radical nephrectomy.

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  FIG. 2 Kaplan-Meier survival curve estimates of the 5-year recurrence-free survival for all patients according to whether they underwent partial nephrectomy or radical nephrectomy.

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  FIG. 3 Kaplan-Meier survival curve estimates of the 5-year cancer-specific survival for all patients according to whether they underwent partial nephrectomy or radical nephrectomy.

Reference

1. Ljungberg B, Hanbury DC, Kuczyk MA, Merseburger AS, Mulders PF, Patard JJ, et al. Renal cell carcinoma guideline. Eur Urol. 2007. 51:1502–1510.

2. Zorn KC, Gong EM, Orvieto MA, Gofrit ON, Mikhail AA, Msezane LP, et al. Comparison of laparoscopic radical and partial nephrectomy: effects on long-term serum creatinine. Urology. 2007. 69:1035–1040.

3. Leibovich BC, Blute ML, Cheville JC, Lohse CM, Weaver AL, Zincke H. Nephron sparing surgery for appropriately selected renal cell carcinoma between 4 and 7 cm results in outcome similar to radical nephrectomy. J Urol. 2004. 171:1066–1070.

4. Lee CT, Katz J, Shi W, Thaler HT, Reuter VE, Russo P. Surgical management of renal tumors 4 cm. or less in a contemporary cohort. J Urol. 2000. 163:730–736.

5. Lau WK, Blute ML, Weaver AL, Torres VE, 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. 75:1236–1242.

6. Clark PE, Schover LR, Uzzo RG, Hafez KS, Rybicki LA, Novick AC. Quality of life and psychological adaptation after surgical treatment for localized renal cell carcinoma: impact of the amount of remaining renal tissue. Urology. 2001. 57:252–256.

7. Nam JK, Cha CS, Chung MK. The treatment outcomes of a partial nephrectomy in the management of renal cell carcinomas. Korean J Urol. 2004. 45:1100–1105.

8. Dash A, Vickers AJ, Schachter LR, Bach AM, Snyder ME, Russo P. Comparison of outcomes in elective partial vs radical nephrectomy for clear cell renal cell carcinoma of 4-7 cm. BJU Int. 2006. 97:939–945.

9. Greene FL, Page DL, Fleming ID, Fritz A, Balch CM, Haller DG, et al. AJCC cancer staging manual. 2002. 6th ed. New York: Springer-Verlag;323–328.

10. Levey AS, Coresh J, Balk E, Kausz AT, Levin A, Steffes MW, et al. National kidney foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med. 2003. 139:137–147.

11. Van Poppel H. Efficacy and safety of nephron-sparing surgery. Int J Urol. 2010. 17:314–326.

12. Jang YH, Ahn H, Kim CS. Renal function after partial nephrectomy for renal cell carcinoma in solitary kidney. Korean J Urol. 2007. 48:1213–1218.

13. Smith SJ, Bosniak MA, Megibow AJ, Hulnick DH, Horii SC, Raghavendra BN. Renal cell carcinoma: earlier discovery and increased detection. Radiology. 1989. 170:699–703.

14. Chow WH, Devesa SS, Warren JL, Fraumeni JF Jr. Rising incidence of renal cell cancer in the United States. JAMA. 1999. 281:1628–1631.

15. 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. 7:735–740.

16. Patard JJ, Shvarts O, Lam JS, Pantuck AJ, Kim HL, Ficarra V, et al. Safety and efficacy of partial nephrectomy for all T1 tumors based on an international multicenter experience. J Urol. 2004. 171:2181–2185.

17. Becker F, Siemer S, Hack M, Humke U, Ziegler M, Stöckle M. Excellent long-term cancer control with elective nephron-sparing surgery for selected renal cell carcinomas measuring more than 4 cm. Eur Urol. 2006. 49:1058–1063.

18. Nemr E, Azar G, Fakih F, Chalouhy E, Moukarzel M, Sarkis P, et al. Partial nephrectomy for renal cancers larger than 4 cm. Prog Urol. 2007. 17:810–814.

19. Patard JJ, Pantuck AJ, Crepel M, Lam JS, Bellec L, Albouy B, et al. Morbidity and clinical outcome of nephron-sparing surgery in relation to tumour size and indication. Eur Urol. 2007. 52:148–154.

20. Lesage K, Joniau S, Fransis K, Van Poppel H. Comparison between open partial and radical nephrectomy for renal tumours: perioperative outcome and health-related quality of life. Eur Urol. 2007. 51:614–620.

21. Weight CJ, Larson BT, Fergany AF, Gao T, Lane BR, Campbell SC, et al. Nephrectomy induced chronic renal insufficiency is associated with increased risk of cardiovascular death and death from any cause in patients with localized cT1b renal masses. J Urol. 2010. 183:1317–1323.

22. Thompson RH, Boorjian SA, Lohse CM, Leibovich BC, Kwon ED, Cheville JC, et al. Radical nephrectomy for pT1a renal masses may be associated with decreased overall survival compared with partial nephrectomy. J Urol. 2008. 179:468–471.

23. Simmons MN, Weight CJ, Gill IS. Laparoscopic radical versus partial nephrectomy for tumors >4 cm: intermediate-term oncologic and functional outcomes. Urology. 2009. 73:1077–1082.