title: A non-cancer-related survival benefit is associated with partial nephrectomy.
abstract: BACKGROUND
  Partial nephrectomy (PN) may better protect against other-cause mortality (OCM) when compared with radical nephrectomy (RN) in patients with localized renal cell carcinoma (RCC).
  
  
  OBJECTIVE
  Test the effect of treatment type on OCM.
  
  
  METHODS
  Using the Surveillance Epidemiology and End Results-Medicare-linked database, 4956 RN patients (82%) and 1068 PN patients (18%) with T1a RCC were identified (1988-2005).
  
  
  METHODS
  To adjust for inherent differences between treatment types, we relied on propensity-matched analyses. One-to-one matching was performed according to age, sex, race, baseline Charlson comorbidity index (CCI), baseline diagnosis of hypercalcemia and hyperlipidemia, socioeconomic status (SES), population density, tumor size, and year of surgery. The 2- and 5-yr OCM rates were computed using cumulative incidence. Univariable and multivariable competing-risks regression analyses for prediction of OCM were performed according to treatment type. Adjustment was made for cancer-specific mortality (CSM), patient age, CCI, sex, race, SES, tumor grade, and year of surgery.
  
  
  CONCLUSIONS
  Following propensity-based matching, 1068 RN patients were matched with 1068 PN patients. The 2- and 5-yr OCM rates after nephrectomy were 5.0% and 16.0% for PN versus 6.9% and 18.1% for RN, respectively. In the postpropensity multivariable analyses, patients who underwent PN were significantly less likely to die of OCM compared with their RN-treated counterparts (hazard ratio [HR]: 0.83; 95% confidence interval, 0.69-0.98; p=0.04). Increasing age (HR: 1.08, p<0.001), higher CCI (HR: 1.14, p<0.001), female gender (HR: 0.79, p=0.02), baseline hypercalcemia (HR: 2.05, p=0.03), baseline hyperlipidemia (HR: 0.73, p=0.003), and year of surgery (HR: 0.95, p=0.003) were independent predictors of OCM.
  
  
  CONCLUSIONS
  Compared with PN-treated patients, RN-treated patients are more likely to die of OCM after surgery, even after adjusting for CSM, as well as baseline CCI. Consequently, PN should be offered whenever technically feasible.
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada. mcw.sun@umontreal.ca
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
authors.forename: Marco
authors.initials: M
authors.lastname: Bianchi
authors.forename: Jens
authors.initials: J
authors.lastname: Hansen
authors.forename: Nawar
authors.initials: N
authors.lastname: Hanna
authors.forename: Firas
authors.initials: F
authors.lastname: Abdollah
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Alberto
authors.initials: A
authors.lastname: Briganti
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Paul
authors.initials: P
authors.lastname: Perrotte
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002423:Cause of Death; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D015999:Multivariate Analysis; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D057216:Propensity Score; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D018426:SEER Program; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States