A comparison of overall survival and perioperative outcomes between partial and radical nephrectomy for cT1b and cT2 renal cell carcinoma-Analysis of a national cancer registry

Vivek Venkatramani, Tulay Sengul, Feng Miao, Bruno Nahar, Nachiketh Soodana Prakash, Sanjaya Swain, Sanoj Punnen, Chad Ritch, Mark L Gonzalgo, Dipen J Parekh

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objectives: Partial nephrectomy (PN) is the standard management of cT1a renal cell carcinoma (RCC), and there is a basis for expanding its indications to larger tumors (cT1b and cT2). We analyzed a large population-based cancer registry to compare the overall survival (OS) and perioperative outcomes in patients with cT1b and cT2 RCC undergoing PN with those undergoing radical nephrectomy (RN). Materials and methods: Patients with cT1bN0M0 and cT2N0M0 RCC were identified from the National Cancer Database (2004-2013). Patients were classified by the surgery performed and 1:1 propensity matched based on the likelihood of receiving PN. They were then compared for OS, 30-day readmission rates and 30- and 90-day mortality. Results: A total of 6,072 patients underwent PN. PN was associated with better OS in cT1b tumors on multivariate analyses (OR = 0.8; 95% CI: 0.72-0.89; P<0.001). For cT2 tumors, PN was associated with better OS, however this was not statistically significant (OR = 0.8; 95% CI: 0.62-1.04; P = 0.092). Unplanned readmission at 30 days was significantly more common in patients undergoing PN (4.2%) vs. RN (2.9%) but there was no difference in 30- and 90-day mortality between the 2 groups. Conclusions: PN was associated with a significantly better OS than RN for cT1b but not cT2 RCC. PN had a higher 30-day readmission rate than RN in these tumors and appropriate patient selection is crucial. These results require further validation, ideally via randomized trials.

Original languageEnglish (US)
JournalUrologic Oncology: Seminars and Original Investigations
DOIs
StateAccepted/In press - Jan 1 2017

Fingerprint

Nephrectomy
Renal Cell Carcinoma
Registries
Survival
Neoplasms
Mortality
Patient Selection
Multivariate Analysis
Databases

Keywords

  • CT1b and cT2
  • Overall survival
  • Partial nephrectomy
  • Perioperative outcomes
  • Radical nephrectomy

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

@article{8130d1ca39fc4b38997012421e56999a,
title = "A comparison of overall survival and perioperative outcomes between partial and radical nephrectomy for cT1b and cT2 renal cell carcinoma-Analysis of a national cancer registry",
abstract = "Objectives: Partial nephrectomy (PN) is the standard management of cT1a renal cell carcinoma (RCC), and there is a basis for expanding its indications to larger tumors (cT1b and cT2). We analyzed a large population-based cancer registry to compare the overall survival (OS) and perioperative outcomes in patients with cT1b and cT2 RCC undergoing PN with those undergoing radical nephrectomy (RN). Materials and methods: Patients with cT1bN0M0 and cT2N0M0 RCC were identified from the National Cancer Database (2004-2013). Patients were classified by the surgery performed and 1:1 propensity matched based on the likelihood of receiving PN. They were then compared for OS, 30-day readmission rates and 30- and 90-day mortality. Results: A total of 6,072 patients underwent PN. PN was associated with better OS in cT1b tumors on multivariate analyses (OR = 0.8; 95{\%} CI: 0.72-0.89; P<0.001). For cT2 tumors, PN was associated with better OS, however this was not statistically significant (OR = 0.8; 95{\%} CI: 0.62-1.04; P = 0.092). Unplanned readmission at 30 days was significantly more common in patients undergoing PN (4.2{\%}) vs. RN (2.9{\%}) but there was no difference in 30- and 90-day mortality between the 2 groups. Conclusions: PN was associated with a significantly better OS than RN for cT1b but not cT2 RCC. PN had a higher 30-day readmission rate than RN in these tumors and appropriate patient selection is crucial. These results require further validation, ideally via randomized trials.",
keywords = "CT1b and cT2, Overall survival, Partial nephrectomy, Perioperative outcomes, Radical nephrectomy",
author = "Vivek Venkatramani and Tulay Sengul and Feng Miao and Bruno Nahar and Prakash, {Nachiketh Soodana} and Sanjaya Swain and Sanoj Punnen and Chad Ritch and Gonzalgo, {Mark L} and Parekh, {Dipen J}",
year = "2017",
month = "1",
day = "1",
doi = "10.1016/j.urolonc.2017.11.008",
language = "English (US)",
journal = "Urologic Oncology: Seminars and Original Investigations",
issn = "1078-1439",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - A comparison of overall survival and perioperative outcomes between partial and radical nephrectomy for cT1b and cT2 renal cell carcinoma-Analysis of a national cancer registry

AU - Venkatramani, Vivek

AU - Sengul, Tulay

AU - Miao, Feng

AU - Nahar, Bruno

AU - Prakash, Nachiketh Soodana

AU - Swain, Sanjaya

AU - Punnen, Sanoj

AU - Ritch, Chad

AU - Gonzalgo, Mark L

AU - Parekh, Dipen J

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Objectives: Partial nephrectomy (PN) is the standard management of cT1a renal cell carcinoma (RCC), and there is a basis for expanding its indications to larger tumors (cT1b and cT2). We analyzed a large population-based cancer registry to compare the overall survival (OS) and perioperative outcomes in patients with cT1b and cT2 RCC undergoing PN with those undergoing radical nephrectomy (RN). Materials and methods: Patients with cT1bN0M0 and cT2N0M0 RCC were identified from the National Cancer Database (2004-2013). Patients were classified by the surgery performed and 1:1 propensity matched based on the likelihood of receiving PN. They were then compared for OS, 30-day readmission rates and 30- and 90-day mortality. Results: A total of 6,072 patients underwent PN. PN was associated with better OS in cT1b tumors on multivariate analyses (OR = 0.8; 95% CI: 0.72-0.89; P<0.001). For cT2 tumors, PN was associated with better OS, however this was not statistically significant (OR = 0.8; 95% CI: 0.62-1.04; P = 0.092). Unplanned readmission at 30 days was significantly more common in patients undergoing PN (4.2%) vs. RN (2.9%) but there was no difference in 30- and 90-day mortality between the 2 groups. Conclusions: PN was associated with a significantly better OS than RN for cT1b but not cT2 RCC. PN had a higher 30-day readmission rate than RN in these tumors and appropriate patient selection is crucial. These results require further validation, ideally via randomized trials.

AB - Objectives: Partial nephrectomy (PN) is the standard management of cT1a renal cell carcinoma (RCC), and there is a basis for expanding its indications to larger tumors (cT1b and cT2). We analyzed a large population-based cancer registry to compare the overall survival (OS) and perioperative outcomes in patients with cT1b and cT2 RCC undergoing PN with those undergoing radical nephrectomy (RN). Materials and methods: Patients with cT1bN0M0 and cT2N0M0 RCC were identified from the National Cancer Database (2004-2013). Patients were classified by the surgery performed and 1:1 propensity matched based on the likelihood of receiving PN. They were then compared for OS, 30-day readmission rates and 30- and 90-day mortality. Results: A total of 6,072 patients underwent PN. PN was associated with better OS in cT1b tumors on multivariate analyses (OR = 0.8; 95% CI: 0.72-0.89; P<0.001). For cT2 tumors, PN was associated with better OS, however this was not statistically significant (OR = 0.8; 95% CI: 0.62-1.04; P = 0.092). Unplanned readmission at 30 days was significantly more common in patients undergoing PN (4.2%) vs. RN (2.9%) but there was no difference in 30- and 90-day mortality between the 2 groups. Conclusions: PN was associated with a significantly better OS than RN for cT1b but not cT2 RCC. PN had a higher 30-day readmission rate than RN in these tumors and appropriate patient selection is crucial. These results require further validation, ideally via randomized trials.

KW - CT1b and cT2

KW - Overall survival

KW - Partial nephrectomy

KW - Perioperative outcomes

KW - Radical nephrectomy

UR - http://www.scopus.com/inward/record.url?scp=85039418517&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85039418517&partnerID=8YFLogxK

U2 - 10.1016/j.urolonc.2017.11.008

DO - 10.1016/j.urolonc.2017.11.008

M3 - Article

C2 - 29254672

AN - SCOPUS:85039418517

JO - Urologic Oncology: Seminars and Original Investigations

JF - Urologic Oncology: Seminars and Original Investigations

SN - 1078-1439

ER -