Renal CancerNephron-sparing Surgery Is Equally Effective to Radical Nephrectomy for T1BN0M0 Renal Cell Carcinoma: A Population-based Assessment
Section snippets
Material and Methods
Patients diagnosed with primary invasive kidney cancer between 1988 and 2004 were identified within 9 SEER cancer registries. The registries include the Atlanta, Detroit, San Francisco-Oakland, and Seattle-Puget Sound Metropolitan areas, as well as the states of Connecticut, Hawaii, Iowa, New Mexico, and Utah. Characteristics of the SEER population are comparable with that of the general population of the United States. The 2 kidney cancer diagnostic codes (International Classification of
Results
The selection criteria resulted in the identification of 5141 patients with T1bN0M0 RCC, aged ≥ 18 years, who had malignant renal cortical tumors sized between 4 and 7 cm. Of those patients, 275 (5.4%) underwent NSS and 4866 (94.6%) had a RN.
The 275 NSS patients were matched with 1100 of 4866 available (22.6%) RN cases. Matching was made for age, tumor size, and year of surgery. When Fuhrman grade was added to the other 3 matching variables, 163 (56.5%) of 275 NSS patients could be matched with
Comment
We hypothesized that NSS would result in the same cancer control rate as RN. Our results confirmed our hypothesis and demonstrated a virtual equivalence of CSM after NSS vs RN in 2 distinct analytic approaches: in Cox and in competing-risks regression models. Therefore, based on cancer control outcomes, our findings suggest that in patients with T1bN0M0 lesions, NSS should be given equal consideration as RN.
The current study focused on 275 NSS cases. The sample size substantially exceeds the
Conclusions
In conclusion, despite its limitations, our study strongly suggests that in patients with T1bN0M0 RCC, NSS does provide equivalent cancer control relative to RN. In consequence, NSS should be given equal consideration as RN when surgical treatment options are considered for T1bN0M0 lesions.
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Pierre I. Karakiewicz is partially supported by the University of Montreal Health Center Urology Associates, Fonds de la Recherche en santé du Quebec, the University of Montreal Department of Surgery and the University of Montreal Health Center (CHUM) Foundation.
Maxime Crépel is partially supported by the Association Française d'urologie.