Increased Risk of Overall and Cardiovascular Mortality After Radical Nephrectomy for Renal Cell Carcinoma 2 cm or Less

被引:71
作者
Kates, Max [1 ]
Badalato, Gina M. [1 ]
Pitman, Max [1 ]
McKiernan, James M. [1 ]
机构
[1] Columbia Univ, Coll Phys & Surg, Dept Urol, New York, NY 10032 USA
关键词
kidney; carcinoma; renal cell; nephrectomy; mortality; SEER program; CHRONIC KIDNEY-DISEASE; CANCER-SPECIFIC SURVIVAL; DEATH CERTIFICATE; CORTICAL TUMORS; ACCURACY; OUTCOMES; SURGERY; MASSES; COHORT;
D O I
10.1016/j.juro.2011.05.054
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Purpose: We used a large, population based registry to assess whether a difference in overall and cardiovascular survival may exist between radical nephrectomy and partial nephrectomy for renal cell carcinoma 2 cm or less. Materials and Methods: From the SEER (Surveillance, Epidemiology and End Results) registry we identified 4,216 patients with histologically confirmed renal cell carcinoma 2 cm or less who were treated with partial or radical nephrectomy. Patient and tumor characteristics were compared between the 2 patient groups. Multivariate logistic regression was done to predict the odds of undergoing radical nephrectomy. Cardiovascular survival and overall survival were compared between the 2 cohorts, adjusting for patient and tumor characteristics. Results: Overall 2,301 patients (55%) underwent partial nephrectomy. Partial nephrectomy use steadily increased during the study period from 27% of all cases in 1998 to 66% in 2007. Patients who underwent partial nephrectomy were an average of 2.5 years younger than those treated with radical nephrectomy (56.4 vs 58.9 years, p < 0.001). They were more likely to be white and from the western or northeastern United States. Older age was the only independent predictor of radical nephrectomy (OR 1.02, 95% CI 1.01-1.03). When controlling for patient characteristics and surgery year, radical nephrectomy was associated with worse overall mortality (HR 2.24, 95% CI 1.75-2.84) and cardiovascular mortality (HR 2.53, 95% CI 1.51-4.23). Conclusions: Radical nephrectomy is associated with worse overall and cardiovascular survival compared to partial nephrectomy in patients with localized renal cell carcinoma 2 cm or less. These findings justify the widespread application of nephron sparing techniques to treat localized kidney cancer.
引用
收藏
页码:1247 / 1253
页数:7
相关论文
共 23 条
[1]   Predicting renal functional outcomes after surgery for renal cortical tumours: a multifactorial analysis [J].
Barlow, LaMont J. ;
Korets, Ruslan ;
Laudano, Melissa ;
Benson, Mitchell ;
McKiernan, James .
BJU INTERNATIONAL, 2010, 106 (04) :489-492
[2]   Guideline for Management of the Clinical T1 Renal Mass [J].
Campbell, Steven C. ;
Novick, Andrew C. ;
Belldegrun, Arie ;
Blute, Michael L. ;
Chow, George K. ;
Derweesh, Ithaar H. ;
Faraday, Martha M. ;
Kaouk, Jihad H. ;
Leveillee, Raymond J. ;
Matin, Surena F. ;
Russo, Paul ;
Uzzo, Robert G. .
JOURNAL OF UROLOGY, 2009, 182 (04) :1271-1279
[3]   Solid renal tumors: An analysis of pathological features related to tumor size [J].
Frank, I ;
Blute, ML ;
Cheville, JC ;
Lohse, CM ;
Weaver, AL ;
Zincke, H .
JOURNAL OF UROLOGY, 2003, 170 (06) :2217-2220
[4]   Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization [J].
Go, AS ;
Chertow, GM ;
Fan, DJ ;
McCulloch, CE ;
Hsu, CY .
NEW ENGLAND JOURNAL OF MEDICINE, 2004, 351 (13) :1296-1305
[5]  
Hankey BF, 1999, CANCER EPIDEM BIOMAR, V8, P1117
[6]   National utilization trends of partial nephrectomy for renal cell carcinoma: A case of underutilization? [J].
Hollenbeck, BK ;
Taub, DA ;
Miller, DC ;
Dunn, RL ;
Wei, JT .
UROLOGY, 2006, 67 (02) :254-259
[7]   Five-year survival after surgical treatment for kidney cancer - A population-based competing risk analysis [J].
Hollingsworth, John M. ;
Miller, David C. ;
Daignault, Stephanie ;
Hollenbeck, Brent K. .
CANCER, 2007, 109 (09) :1763-1768
[8]   Rising incidence of small renal masses: A need to reassess treatment effect [J].
Hollingsworth, John M. ;
Miller, David C. ;
Daignault, Stephanie ;
Hollenbeck, Brent K. .
JNCI-JOURNAL OF THE NATIONAL CANCER INSTITUTE, 2006, 98 (18) :1331-1334
[9]   Improved Estimates of Cancer-Specific Survival Rates From Population-Based Data [J].
Howlader, Nadia ;
Ries, Lynn A. G. ;
Mariotto, Angela B. ;
Reichman, Marsha E. ;
Ruhl, Jennifer ;
Cronin, Kathleen A. .
JOURNAL OF THE NATIONAL CANCER INSTITUTE, 2010, 102 (20) :1584-1598
[10]  
Huang WC, 2006, LANCET ONCOL, V7, P735, DOI 10.1016/S1470-2045(06)70803-8