1. A population-based comparison of survival after nephrectomy vs nonsurgical management for small renal masses
- Author
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Paul Perrotte, Pierre I. Karakiewicz, Laurent Zini, Martine Jolivet-Tremblay, Claudio Jeldres, Arnauld Villers, Francesco Montorsi, Alain Duclos, Philippe Arjane, François Péloquin, Umberto Capitanio, Daniel Pharand, Jean Jacques Patard, Service d'urologie, Hôpital Huriez-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Cancer Prognostics and Health Outcome Unit, Université de Montréal (UdeM), Cancer Prognostics and Health Outcomes Unit, Department of urology, Università Vita-Salute San Raffaele, Institut de Génétique et Développement de Rennes (IGDR), Université de Rennes (UR)-Centre National de la Recherche Scientifique (CNRS), Service d'urologie [Rennes] = Urology [Rennes], Hôpital Pontchaillou-CHU Pontchaillou [Rennes], De Villemeur, Hervé, Centre National de la Recherche Scientifique (CNRS)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Zini, Laurent, Perrotte, Paul, Jeldres, Claudio, Capitanio, Umberto, Duclos, Alain, Jolivet Tremblay, Martine, Arjane, Philippe, Peloquin, Francoi, Pharand, Daniel, Villers, Arnauld, Montorsi, Francesco, Patard Jean, Jacque, and Karakiewicz Pierre, I.
- Subjects
Nephrology ,Male ,[SDV.MHEP.CHI] Life Sciences [q-bio]/Human health and pathology/Surgery ,medicine.medical_treatment ,030232 urology & nephrology ,MESH: Epidemiologic Methods ,[SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology ,Nephrectomy ,0302 clinical medicine ,Renal cell carcinoma ,MESH: Risk Factors ,Risk Factors ,Cumulative incidence ,MESH: Treatment Outcome ,MESH: Aged ,education.field_of_study ,MESH: Middle Aged ,MESH: Carcinoma, Renal Cell ,Middle Aged ,Prognosis ,Kidney Neoplasms ,3. Good health ,Treatment Outcome ,030220 oncology & carcinogenesis ,MESH: Survival Analysis ,MESH: SEER Program ,Female ,medicine.medical_specialty ,Urology ,Population ,[SDV.CAN]Life Sciences [q-bio]/Cancer ,[SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery ,MESH: Prognosis ,03 medical and health sciences ,[SDV.CAN] Life Sciences [q-bio]/Cancer ,Internal medicine ,medicine ,MESH: United States ,Humans ,education ,Carcinoma, Renal Cell ,Survival analysis ,Aged ,MESH: Humans ,business.industry ,medicine.disease ,[SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology ,Survival Analysis ,MESH: Male ,United States ,Surgery ,MESH: Nephrectomy ,MESH: Kidney Neoplasms ,business ,Epidemiologic Methods ,Kidney cancer ,MESH: Female ,Kidney disease ,SEER Program - Abstract
OBJECTIVE To examine population-based rates of cancer-specific and other-cause mortality after either non-surgical management (NSM) or nephrectomy, in patients with small renal masses, as several reports from selected institutions support the applicability of surveillance in patients with small renal masses, but there are no population-based studies confirming the general applicability of this therapy. PATIENTS AND METHODS Of 43 143 patients with renal cell carcinoma identified in the 1988–2004 Surveillance, Epidemiology and End Results database, 10 291 had localized small renal masses (≤4 cm) and were offered NSM (433, 4.2%) or nephrectomy (9858, 95.8%). Univariable matched and multivariable unmatched competing-risks regression models were used in the analyses. RESULTS Cumulative incidence plots based on unmatched data, where the effect of other-cause mortality was controlled for, showed a 5.2%, 6.5% and 9.4% survival benefit for nephrectomy vs NSM at 1, 2 and 5 years after nephrectomy or diagnosis, respectively. The same magnitude of the benefit (4.5%, 5.6% and 8.0%) persisted in analyses matched for age, tumour size and year of diagnosis or of nephrectomy. Finally, in multivariable analyses, treatment type, age, tumour size and year of diagnosis or of nephrectomy were independent predictors. CONCLUSION Relative to nephrectomy, NSM appears to undermine the overall and cancer-specific survival of patients with small renal masses by as much as 9.4%, at 5 years.
- Published
- 2009