title: Nephron-sparing surgery is equally effective to radical nephrectomy for T1BN0M0 renal cell carcinoma: a population-based assessment.
abstract: OBJECTIVE
  To test the effect of nephron-sparing surgery (NSS) vs radical nephrectomy (RN) on cancer-specific mortality (CSM) in patients with T1bN0M0 renal cell carcinoma (RCC) in a population-based cohort. To date, only few series from tertiary care centers supported the use of NSS for T1bN0M0 (range 4-7 cm) RCC.
  
  
  METHODS
  The Surveillance, Epidemiology, and End Results database allowed us to identify 275 NSS (5.3%) and 4866 RN (94.7%) patients treated for T1bN0M0 RCC between 1988 and 2004. Analyses matched for age, year of surgery, tumor size, and Fuhrman grade addressed the effect of nephrectomy type (NSS vs RN) on CSM.
  
  
  RESULTS
  Five years after surgery, the surviving proportions of NSS and RN patients matched for age, tumor size, and year of surgery were respectively 91.4 and 95.3% and 90.1 and 93.8% in the cohort, where additional matching for Fuhrman grade was performed. Neither of the matched analyses resulted in statistically significant CSM difference (P = .1 and .4) between NSS and RN. Similarly, competing-risks regression analyses based on both matching schemes also failed to reveal statistically significant CSM differences (P = .3 and .3).
  
  
  CONCLUSIONS
  Our study represents the largest and the only population-based analysis of cancer control efficacy of NSS vs RN in T1bN0M0 RCC. It indicates that NSS does provide equivalent cancer control relative to RN. In consequence, based on cancer control equivalence, NSS should be given equal consideration to RN in patients with T1bN0M0 lesions.
authors: Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, Quebec, Canada.
authors: Maxime
authors: M
authors: Crépel
authors: Claudio
authors: C
authors: Jeldres
authors: Paul
authors: P
authors: Perrotte
authors: Umberto
authors: U
authors: Capitanio
authors: Hendrik
authors: H
authors: Isbarn
authors: Shahrokh F
authors: SF
authors: Shariat
authors: Daniel
authors: D
authors: Liberman
authors: Maxine
authors: M
authors: Sun
authors: Giovanni
authors: G
authors: Lughezzani
authors: Philippe
authors: P
authors: Arjane
authors: Hugues
authors: H
authors: Widmer
authors: Markus
authors: M
authors: Graefen
authors: Francesco
authors: F
authors: Montorsi
authors: Jean-Jacques
authors: JJ
authors: Patard
authors: Pierre I
authors: PI
authors: Karakiewicz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods*; D009399:Nephrons; D055815:Young Adult