Recurrence after radical and partial nephrectomy in high complex renal tumor using propensity score matched analysis

Abstract

We evaluated the recurrence after radical and partial nephrectomy in patients with RENAL nephrometry score [RENAL] ≥ 10. A total of 474 patients (radical nephrectomy [RN, n = 236] & partial nephrectomy [PN, n = 238]) in a single tertiary referral institution from December 2003 to December 2019 were assessed. Functional outcomes, defined as estimated glomerular filtration rate changes, relapse pattern, recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were evaluated using propensity score-matched analysis. The predictors of recurrence and survival were assessed by Cox-regression analysis. 44 patients in the RN group and 88 in the PN group were included without significant differences in preoperative clinical factors after matching. The PN patients achieved significantly higher renal function preservation rates (p < 0.001). There were five recurrences in RN and six in PN. The PN patients revealed 5-year RFS rate (86.8%), 5-year CSS rate (98.5%), and 5-year OS rate (98.5%) comparable to the RN patients (RFS: 88.7% [p = 0.780], CSS: 96.7% [p = 0.375], and OS: 94.3% [p = 0.248]). Patients with a body mass index (BMI) ≥ 23 had lower 5-year RFS rates (85.5%) and OS rates (95.6%) than those with BMI < 23 (RFS: 90.0% [p = 0.195], OS: 100% [p = 0.117]) without significance. The significant predictor of recurrence was the pathologic T stage (hazard ratio [HR] 3.99, 95% confidence [CI] 1.10–14.50, p = 0.036). The significant predictor of death was the R domain of the RENAL (HR 3.80, 95% CI 1.03–14.11, p = 0.046). PN, if technically feasible, could be considered to preserve renal function in patients with RENAL ≥ 10. Nonetheless, PN needs to be implemented with caution in some patients due to the higher potentiality for recurrence and poor survival.

Partial Nephrectomy Versus Radical Nephrectomy for Endophytic Renal Tumors: Comparison of Operative, Functional, and Oncological Outcomes by Propensity Score Matching Analysis

“…Multivariate analysis showed that the significant predictor of 48-h postoperative AKI was the surgical method, whereby the risk in the RN group was 2.812 times greater than the PN group (p = 0.005). In other comparative studies between PN and RN groups, significant differences in perioperative decreased renal function were observed not only for small tumors but also for anatomically complicated tumors (22,35). The quality and quantity of preserved parenchyma are the main contributors to postoperative long-term renal function (36).…”

“…In this retrospective study, compared with patients who underwent PN, those who underwent RN were more likely to be the elderly with a poor general condition or larger tumor size, and highly complex tumors with high RENAL-NS. Such biases can be identified in other comparative studies between different surgical methods (partial and radical nephrectomy) (22)(23)(24). To eliminate selection bias and the influence of confounding factors, PSM analysis was conducted, as shown in Table 1.…”

Predicting Clear Cell Renal Cell Carcinoma Survival Using Kurtosis of Cytoplasm in the Hematoxylin Channel from Histology Slides

“…However, renal tumor recurrence occurred in some patients after partial nephrectomy [ 15 , 16 ]. Local recurrence rates of 1.2% to 9% have been reported [ 15 , 17 ]. In fact, tumor tissue samples obtained during partial nephrectomy are underutilized.…”

Pleiotropic effects of DCLK1 in cancer and cancer stem cells

“…Renal cell carcinoma (RCC) is a cancer caused due to distance metastasis ( Hoffmann et al, 2008 ; Chandrasekar et al, 2017 ). The main problem in RCC is poor prognosis due to rapid relapse after surgery and therapy resistance ( Kucharczyk et al, 2017 ; Ge et al, 2018 ; Kim et al, 2021 ). Ge et al (2018) in their experiment have shown that DCLK1 long isoforms express CSC markers and are prognostic factors in RCC.…”