title: A population-based comparison of survival after nephrectomy vs nonsurgical management for small renal masses.
abstract: OBJECTIVE
  To examine population-based rates of cancer-specific and other-cause mortality after either non-surgical management (NSM) or nephrectomy, in patients with small renal masses, as several reports from selected institutions support the applicability of surveillance in patients with small renal masses, but there are no population-based studies confirming the general applicability of this therapy.
  
  
  METHODS
  Of 43 143 patients with renal cell carcinoma identified in the 1988-2004 Surveillance, Epidemiology and End Results database, 10 291 had localized small renal masses (<or=4 cm) and were offered NSM (433, 4.2%) or nephrectomy (9858, 95.8%). Univariable matched and multivariable unmatched competing-risks regression models were used in the analyses.
  
  
  RESULTS
  Cumulative incidence plots based on unmatched data, where the effect of other-cause mortality was controlled for, showed a 5.2%, 6.5% and 9.4% survival benefit for nephrectomy vs NSM at 1, 2 and 5 years after nephrectomy or diagnosis, respectively. The same magnitude of the benefit (4.5%, 5.6% and 8.0%) persisted in analyses matched for age, tumour size and year of diagnosis or of nephrectomy. Finally, in multivariable analyses, treatment type, age, tumour size and year of diagnosis or of nephrectomy were independent predictors.
  
  
  CONCLUSIONS
  Relative to nephrectomy, NSM appears to undermine the overall and cancer-specific survival of patients with small renal masses by as much as 9.4%, at 5 years.
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada.
authors.forename: Laurent
authors.initials: L
authors.lastname: Zini
authors.forename: Paul
authors.initials: P
authors.lastname: Perrotte
authors.forename: Claudio
authors.initials: C
authors.lastname: Jeldres
authors.forename: Umberto
authors.initials: U
authors.lastname: Capitanio
authors.forename: Alain
authors.initials: A
authors.lastname: Duclos
authors.forename: Martine
authors.initials: M
authors.lastname: Jolivet-Tremblay
authors.forename: Philippe
authors.initials: P
authors.lastname: Arjane
authors.forename: François
authors.initials: F
authors.lastname: Péloquin
authors.forename: Daniel
authors.initials: D
authors.lastname: Pharand
authors.forename: Arnauld
authors.initials: A
authors.lastname: Villers
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Patard
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods / Q000401:mortality*; D011379:Prognosis; D012307:Risk Factors; D018426:SEER Program; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology