Compared with radical nephrectomy, nephron-sparing surgery offers a long-term survival advantage in patients between the ages of 20 and 44 years with renal cell carcinomas (≤4 cm): an analysis of the SEER database.
OBJECTIVE
Compared with radical nephrectomy (RN), partial nephrectomy (PN) decreases the risk of developing chronic kidney disease. Although numerous studies have demonstrated the survival advantage of PN in older patients, they have been criticized by selection bias toward the procedure owing to comorbidities. We hypothesized that long-standing effects of renal preservation would manifest in a survival advantage of a younger patient population, where selection bias owing to comorbidities is minimized.


METHODS
The Surveillance, Epidemiology, and End Results 18-registries database was queried for patients aged 20 to 44 years surgically treated between 1993 and 2003 for renal cell carcinoma (RCC) ≤ 4 cm with known grade and histology. Patients with prior RCC, multiple tumors, and metastatic or locally advanced disease were excluded. The final cohorts consisted of 222 and 494 subjects treated with PN and RN, respectively. The chi-square and log-rank analyses compared patient and tumor characteristics and patient survival, respectively.


RESULTS
There were no differences between the groups in demographics or tumor characteristics. Additionally, there was no difference in cancer-specific survival at 5 or 10 years (P = 0.34 and P = 0.1, respectively). Although there was no difference in 5-year overall survival (P = 0.07), PN offered an advantage in 10-year overall survival (P = 0.025).


CONCLUSIONS
Present Surveillance, Epidemiology, and End Results analyses demonstrate that compared with RN, PN improved overall survival in patients with small, localized RCC. As expected, the survival advantage is observed late and supports the importance of long-term renal functional preservation. Although our study is limited by lack of comorbidities, the results suggest that detrimental effects of RN may have implications on overall survival in younger patients with RCC.
Department of Urology, SUNY Upstate Medical University, Syracuse, NY.
Michael
M
Daugherty
Department of Urology, SUNY Upstate Medical University, Syracuse, NY. Electronic address: bratslag@upstate.edu.
Gennady
G
Bratslavsky
D000328:Adult; D002292:Carcinoma, Renal Cell / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery*; D016009:Chi-Square Distribution; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery*; D008297:Male; D009392:Nephrectomy / Q000379:methods*; D009399:Nephrons / Q000601:surgery*; D012189:Retrospective Studies; D018426:SEER Program; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
Long-term outcomes; Outcomes; Partial nephrectomy; Renal surgery