Survival benefit of partial nephrectomy: Reconciling experimental and observational data

Tan, Hung‐Jui

doi:10.1016/j.urolonc.2015.08.002

Cited by 5 publications

(3 citation statements)

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“…The estimated number of new cases of RCC in the United States in 2015 was 61560, representing approximately 3.7% of all new cases, and the estimated deaths were 14080, accounting for nearly 2.4% of the total cancer mortality[1]. Early-stage RCC patients treated with nephrectomy may have a satisfying five-year survival expectancy[2, 3]. Once metastasis occurs, molecular-targeted therapy and immunotherapy are the only ways to treat RCC due to its poor response to radiotherapy and chemotherapy[4–9].…”

Section: Introductionmentioning

confidence: 99%

Prognostic Value of Serum Lactate Dehydrogenase in Renal Cell Carcinoma: A Systematic Review and Meta-Analysis

et al. 2016

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BackgroundRecently, many studies have shown that the serum lactate dehydrogenase (LDH) level is related to the prognosis of renal cell carcinoma (RCC). We launched this meta-analysis to assess the prognostic value of serum LDH in patients with RCC.MethodsWe searched PubMed, Embase and Web of Science for information on serum LDH and the outcome of RCC through June 14, 2016. The hazard ratio (HR) and its 95% confidence interval (CI) for overall survival (OS) and progression-free survival (PFS) were extracted and integrated from the matching studies.ResultsA total of 29 studies including 6629 patients with RCC were incorporated in this meta-analysis. Patients whose serum LDH levels were elevated had a lower OS (HR = 2.13, 95% CI = 1.69–2.69, P < 0.001). Meanwhile, the pooled data showed that a higher serum LDH level was a negative prognostic factor for PFS (HR = 1.74, 95% CI = 1.48–2.04, P < 0.001). Furthermore, subgroup analyses indicated elevated serum LDH was associated with poor survival in different tumor types. Elevated serum LDH was significantly associated with worse prognosis for patients with all stages of RCC (OS, HR = 2.41, 95% CI = 1.09–5.33), metastatic RCC (OS, HR = 2.62, 95% CI 1.57–2.59; CSS, HR = 1.79, 95% CI 1.49–2.15), and non-metastatic RCC (OS, HR = 3.67, CI = 1.33–10.13). Besides, elevated serum LDH also indicated a worse prognosis in subgroups of cut-off values, analysis types and ethnicity.ConclusionsOur results show that serum LDH levels are associated with the outcomes of RCC and can be used as a valuable biomarker for monitoring prognoses.

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Section: Introductionmentioning

confidence: 99%

Prognostic Value of Serum Lactate Dehydrogenase in Renal Cell Carcinoma: A Systematic Review and Meta-Analysis

et al. 2016

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“…Surgery for localized RCC disease is usually curative treatment. Local ablation, partial nephrectomy, or total nephrectomy may be performed, depending on tumor size (27). Similar local recurrence rates have been reported with partial nephrectomy and local ablation therapy.…”

Section: Discussionmentioning

confidence: 70%

Evaluation of General Characteristics of Renal Cell Carcinoma Patients: A Single Center Experience

Üyetürk¹,

Duman²,

Yılmaz³

et al. 2018

uob

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Renal cancer (RC) accounts for 3.2% of all newly diagnosed cancers, 4.1% in males and 2.5% in females (1). Approximately 90% of RCs are renal cell carcinoma (RCC). Based on tumor morphology, immunohistochemistry, cytogenetics, and other molecular studies, the subtypes of RCC are clear cell, papillary, chromophobe, and collecting-duct or Bellini duct tumors. The most common subtype of RCC is clear cell carcinoma, with a rate of approximately 80% (2,3,4). Cigarette smoking and hypertension are the most important risk factors in the development of RCC (5,6). Surgery is very important in the treatment of RCC (7). As more patients are diagnosed in the early stages, partial nephrectomy is increasingly used instead of radical nephrectomy for treatment. RCC is a radioresistant tumor; thus, radiotherapy (RT) cannot be used in its treatment. RT can only be performed as palliative treatment in conditions such as brain and bone metastasis (8,9). Systemic treatment is not necessary Objective: Renal cancer (RC) accounts for 3.2% of all newly diagnosed cancers and approximately 90% of RC cases are renal cell carcinoma (RCC). Smoking and hypertension are the most important risk factors. The aim of our study was to evaluate the general characteristics of RCC patients in Bolu, Turkey. Materials and Methods: Patients who visited our medical oncology clinic and were diagnosed with RCC between January 1 st , 2012 and May 31 st , 2017 were evaluated retrospectively. Results: Eighty-one patients were diagnosed with RCC during the study period. The median age of the patients was 62 years (range: 38-87 years). Fifty-seven (70.4%) of the patients were male and 24 (29.6%) were female. Thirty patients (37.1%) were diagnosed incidentally. Forty-eight (59.3%) of the patients were smokers. The most common comorbidity was hypertension (58%). Radical nephrectomy was performed in 59 (72.8%) of the patients. The most common histological subtype was clear cell carcinoma (72.8%) and 39 (48.1%) were stage 1 when evaluated according to the stage of RCC. Of the 16 patients with metastatic disease, 11 (13.6%) received interferon therapy, and 5 patients (6.2%) refused treatment. After interferon treatment, 7 patients received targeted therapy with sunitinib/pazopanib as second-line treatment, 5 received everolimus as third-line treatment, and 3 received axitinib treatment as fourth-line treatment. Ten patients with bone metastasis underwent palliative radiotherapy. The median follow-up time of the patients was 21 months (0-123 months). Sixty-five patients (80.2%) survived this period. Conclusion: Smoking cessation and effective treatment of hypertension, preventable etiological factors of RCC, and incidental diagnosis of early RCC are very important. With early diagnosis, the partial nephrectomy rate might be increased.

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“…Tan [ 18 ] reviewed various experimental or observational studies and found that there was a large potential bias with regards to surgery selection; and that one intrinsic property of observational studies was that high-risk patients were prone to receive radical nephrectomy. Shuch et al [ 19 ] concluded that the SEER-Medicare dataset was biased involving unmeasured confounders based on the use of two matched control groups.…”

Section: Discussionmentioning

confidence: 99%

Nephron Sparing Surgery Has Better Oncologic Outcomes Than Extirpative Nephrectomy in T1a but Not in T1b or T2 Stage Renal Cell Carcinoma

et al. 2017

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BackgroundThe aim of this study was to investigate the benefit of nephron sparing surgery (NSS) compared with extirpative nephrectomy in different tumor stages of renal cell carcinoma.Material/MethodsWe reviewed the Surveillance, Epidemiology and End Results (SEER) database for NSS and extirpative nephrectomy in localized (stages T1–2N0M0) renal cell carcinoma diagnosed after 2004. We used the variable screening function of the SEER database to identified 55,947 cases that met inclusion and exclusion criteria for survival analysis. Overall mortality and cancer-specific mortality were the primary index outcomes. Stratification analysis was done by T stage subgroups. We also performed survival analysis using propensity score analysis, and changed the survival model to the competing-risk model for cancer-specific mortality analysis.ResultsOverall, NSS significantly decreased the risk of overall mortality (HR 0.717, 0.668–0.769) and cancer-specific mortality (HR 0.604, 0.525–0.694) when compared to extirpative nephrectomy. In subgroup analysis, NSS had a lower overall mortality risk and cancer-specific mortality compared to extirpative nephrectomy only for T1a stage renal cell carcinoma (HR 0.654, 0.599–0.714, p<0.01 and HR 0.554, 0.458–0.670, p<0.01, respectively), but not for T1b or T2 stage. The propensity score analysis, which included standardized mortality ratio weight adjustment, showed the same results. Additionally, for cancer-specific mortality, a competing-risk model gave the exactly same outcome.ConclusionsCompared to extirpative nephrectomy, NSS provided superior overall survival and cancer-specific survival for localized renal cell carcinoma only in T1a stage, not in T1b or T2 stage. NSS should be recommended when the surgery is possible. Further prospective study is needed to confirm this result.

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Survival benefit of partial nephrectomy: Reconciling experimental and observational data

Cited by 5 publications

References 46 publications

Prognostic Value of Serum Lactate Dehydrogenase in Renal Cell Carcinoma: A Systematic Review and Meta-Analysis

Prognostic Value of Serum Lactate Dehydrogenase in Renal Cell Carcinoma: A Systematic Review and Meta-Analysis

Evaluation of General Characteristics of Renal Cell Carcinoma Patients: A Single Center Experience

Nephron Sparing Surgery Has Better Oncologic Outcomes Than Extirpative Nephrectomy in T1a but Not in T1b or T2 Stage Renal Cell Carcinoma

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