title: Nephrectomy improves the survival of patients with locally advanced renal cell carcinoma.
abstract: OBJECTIVE
  To examine the cancer-specific survival of patients treated with nephrectomy and compared it to that of patients managed without surgery.
  
  
  METHODS
  Of 43,143 patients with renal cell carcinoma (RCC) identified in the 1988-2004 Surveillance, Epidemiology and End Results database, 7068 had locally advanced RCC and with no distant metastasis. These patients had a nephrectomy (6786, 96.0%) or no surgical therapy (282, 4.0%). Multivariable Cox regression models, and matched and unmatched Kaplan-Meier survival analyses, were used to compare the effect of nephrectomy vs non-surgical therapy on cancer-specific survival. Also, competing-risks regression models adjusted for the effect of other-cause mortality. Covariates and matching variables consisted of age, gender, tumour size and year of diagnosis.
  
  
  RESULTS
  The 1-, 2-, 5- and 10-year cancer-specific survival of patients who had nephrectomy was 88.9%, 88.1%, 68.6% and 57.5%, vs 44.8%, 30.6%, 14.5% and 10.6% for non-surgical therapy. In multivariable analyses, relative to nephrectomy, non-surgical therapy was associated with a 5.8-fold higher rate of cancer-specific mortality (P < 0.001). Non-surgical therapy was also associated with a 5.1-fold higher rate of cancer-specific mortality in matched analyses (P < 0.001). Finally, competing-risks regression confirmed the statistical significance of the variable defining treatment type (nephrectomy vs non-surgical therapy) in multivariable and matched analyses (P < 0.001).
  
  
  CONCLUSIONS
  Relative to non-surgical treatment, nephrectomy improves the cancer-specific survival of patients with locally advanced RCC; our findings await prospective confirmation.
authors: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.
authors: Laurent
authors: L
authors: Zini
authors: Paul
authors: P
authors: Perrotte
authors: Claudio
authors: C
authors: Jeldres
authors: Umberto
authors: U
authors: Capitanio
authors: Daniel
authors: D
authors: Pharand
authors: Philippe
authors: P
authors: Arjane
authors: Steven
authors: S
authors: Lapointe
authors: Francesco
authors: F
authors: Montorsi
authors: Jean-Jacques
authors: JJ
authors: Patard
authors: Pierre I
authors: PI
authors: Karakiewicz
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000401:mortality* / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome