Comparing long-term outcomes following radical and partial nephrectomy for cT1 renal cell carcinoma in young individuals
BAUS ePoster online library. Tan W. 06/25/19; 259578; P8-2
Dr. Wei Shen Tan
Dr. Wei Shen Tan
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Abstract
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BACKGROUND

Despite randomized data demonstrating better overall survival (OS) favouring radical nephrectomy, partial nephrectomy continues to be the treatment of choice for low stage renal cell carcinoma (RCC).

Methods

We utilized the National Cancer Database (NCDB) to identify patients aged <50 years diagnosed with low stage RCC (cT1) treated with radical nephrectomy or partial nephrectomy (2004-2007). Inverse probability of treatment weighting (IPTW) adjustment was performed for all preoperative factors to account for confounding factors. Kaplan-Meier curves and Cox proportional hazards regression analyses were used to compare OS of patients in the two treatment arms. Sensitivity analysis was performed to explore the interaction of type of surgery and clinical stage on OS.

Results
Among the 3,009 patients (median age: 44 years (IQR: 40-47)), 2,454 patients (81.6%) were treated with radical nephrectomy and 555 patients (18.4%) treated with partial nephrectomy. Median follow-up was 108.6 months (IQR: 80.2-124.3) during which, 297 patients (12.1%) in the radical nephrectomy arm and 58 patients (10.5%) in the partial nephrectomy arm died. Following IPTW adjustment, there was no difference in OS between patients treated with partial nephrectomy and radical nephrectomy (Hazard Ratio (HR): 0.83, 95% CI: 0.63-1.10, p=0.196). There were no significant interactions between type of surgery and clinical stage on treatment outcome.

Conclusions
There was no difference in long-term OS between radical and partial nephrectomy in young patients. This patient cohort may have sufficient renal reserve over their lifetime and preserving nephrons by partial nephrectomy may be unnecessary.
BACKGROUND

Despite randomized data demonstrating better overall survival (OS) favouring radical nephrectomy, partial nephrectomy continues to be the treatment of choice for low stage renal cell carcinoma (RCC).

Methods

We utilized the National Cancer Database (NCDB) to identify patients aged <50 years diagnosed with low stage RCC (cT1) treated with radical nephrectomy or partial nephrectomy (2004-2007). Inverse probability of treatment weighting (IPTW) adjustment was performed for all preoperative factors to account for confounding factors. Kaplan-Meier curves and Cox proportional hazards regression analyses were used to compare OS of patients in the two treatment arms. Sensitivity analysis was performed to explore the interaction of type of surgery and clinical stage on OS.

Results
Among the 3,009 patients (median age: 44 years (IQR: 40-47)), 2,454 patients (81.6%) were treated with radical nephrectomy and 555 patients (18.4%) treated with partial nephrectomy. Median follow-up was 108.6 months (IQR: 80.2-124.3) during which, 297 patients (12.1%) in the radical nephrectomy arm and 58 patients (10.5%) in the partial nephrectomy arm died. Following IPTW adjustment, there was no difference in OS between patients treated with partial nephrectomy and radical nephrectomy (Hazard Ratio (HR): 0.83, 95% CI: 0.63-1.10, p=0.196). There were no significant interactions between type of surgery and clinical stage on treatment outcome.

Conclusions
There was no difference in long-term OS between radical and partial nephrectomy in young patients. This patient cohort may have sufficient renal reserve over their lifetime and preserving nephrons by partial nephrectomy may be unnecessary.

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