title: Cancer control of partial nephrectomy for high-risk localized renal cell carcinoma: population-based and single-institutional analysis.
abstract: OBJECTIVE
  Cancer control of partial nephrectomy for high-risk localized renal cell carcinoma is unclear. To assess whether PN provides adequate cancer control in high-risk disease (HRD), survival outcomes were compared in both a population-based cohort and an institutional cohort.
  
  
  METHODS
  Surveillance, Epidemiology, and End Results database and a prospectively maintained institutional database were queried for patients with RCC who underwent PN or RN for a localized tumor ≤7 cm and were found to have high-grade and/or high-stage disease (HRD). Cancer-specific (CSS) or recurrence-free survival (RFS) and overall survival (OS) were primary outcomes measured and were compared between those who underwent PN and RN using multivariable Cox proportional hazards and propensity analysis.
  
  
  RESULTS
  The population cohort consisted of 12,757 (24.9 %) patients with HRD, 85.2 and 14.8 % of which underwent RN and PN, respectively. RN was not associated with CSS (HR 1.23, p = 0.08) but was independently associated with poor OS (HR 1.16, p = 0.031). Propensity analysis showed that RN resulted in a 20 % increased risk of death from all causes (p = 0.008). In the institutional cohort, of 317 patients, 35.9 % had HRD, 56 and 52 of which underwent RN and PN, respectively. Adjusting for age-adjusted Charlson index, RN was a predictor of poor OS (OR 6.20, p = 0.041). Propensity analysis showed that RFS and OS were not related to nephrectomy type (RN HR 0.65, p = 0.627 and RN HR 1.70, p = 0.484).
  
  
  CONCLUSIONS
  In patients with pathologic high-risk RCC, partial excision is associated with similar cancer control as compared to radical excision.
authors: Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA. romalley@communitycare.com.|Department of Surgery, Albany Medical College, Urologic Institute of Northeastern New York, 23 Hackett Blvd., MC-208, Albany, NY, 12208, USA. romalley@communitycare.com.
authors: Rebecca L
authors: RL
authors: O'Malley
authors: Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA.|Department of Urology, Maine Medical Center, Portland, ME, USA.
authors: Matthew H
authors: MH
authors: Hayn
authors: Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA.
authors: Katherine A
authors: KA
authors: Brewer
authors: Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA.
authors: Willie
authors: W
authors: Underwood
authors: Division of Urology, Department of Surgery, Bassett Healthcare, Cooperstown, NY, USA.
authors: Nicholas J
authors: NJ
authors: Hellenthal
authors: Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA.|Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors: Hyung L
authors: HL
authors: Kim
authors: Department of Surgery, Albany Medical College, Urologic Institute of Northeastern New York, 23 Hackett Blvd., MC-208, Albany, NY, 12208, USA.
authors: Igor
authors: I
authors: Sorokin
authors: Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA.
authors: Thomas
authors: T
authors: Schwaab
mesh_terms: D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D009392:Nephrectomy; D009518:New York / Q000453:epidemiology; D011159:Population Surveillance / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D057216:Propensity Score; D012189:Retrospective Studies; D012307:Risk Factors; D018426:SEER Program; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
keywords: Complications; Mortality; Nephrectomy; Outcomes; Renal cell carcinoma