title: Elective Nephron Sparing Surgery Decreases Other Cause Mortality Relative to Radical Nephrectomy Only in Specific Subgroups of Patients with Renal Cell Carcinoma.
abstract: OBJECTIVE
  There is no consensus regarding a protective effect on mortality due to a cause other than cancer in patients treated with elective nephron sparing surgery relative to their radical nephrectomy counterparts. We test whether the protective effect of nephron sparing surgery relative to radical nephrectomy is universal or present in specific subgroups of patients.
  
  
  METHODS
  A collaborative database of 5 institutions was queried to evaluate 1,783 patients without chronic kidney disease diagnosed with a clinical T1 renal mass that was treated with nephron sparing surgery or radical nephrectomy. Multivariable Cox regression analysis was done to assess the impact of surgery type (nephron sparing surgery vs radical nephrectomy) on other cause mortality after adjustment for patient and cancer characteristics. Interaction terms were used to test the hypothesis that the impact of surgery type varies according to specific subcohorts of patients.
  
  
  RESULTS
  Ten-year other cause mortality-free survival rates were 90% and 88% after nephron sparing surgery and radical nephrectomy, respectively. In the overall population radical nephrectomy was not associated with an increased risk of other cause mortality on multivariable analysis compared to nephron sparing surgery (HR 0.91, 95% CI 0.6-1.38, p = 0.6). However, radical nephrectomy increased the risk of other cause mortality according to the increasing baseline Charlson comorbidity index (interaction test p = 0.0008). For example, in a patient with a Charlson comorbidity index of 4 the probability of 10-year other cause mortality-free survival was 86% after nephron sparing surgery and 60% after radical nephrectomy.
  
  
  CONCLUSIONS
  Elective nephron sparing surgery does not improve other cause survival relative to radical nephrectomy consistently in all patients with kidney cancer. Patients who are more ill with relevant comorbidities are those who benefit the most from nephron sparing surgery in terms of other cause mortality.
authors.affiliation: Urological Research Institute, Division of Experimental Oncology, Istituto di Ricovero e Cura a Carattere Scientifico and Unit of Urology, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Larcher
authors.affiliation: Urological Research Institute, Division of Experimental Oncology, Istituto di Ricovero e Cura a Carattere Scientifico and Unit of Urology, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy. Electronic address: umbertocapitanio@gmail.com.
authors.forename: Umberto
authors.initials: U
authors.lastname: Capitanio
authors.affiliation: Department of Urology, University of Piemonte Orientale, Novara, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Terrone
authors.affiliation: Department of Urology, University of Piemonte Orientale, Novara, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Volpe
authors.affiliation: Department of Urology, University of Piemonte Orientale, Novara, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: De Angelis
authors.affiliation: Urological Research Institute, Division of Experimental Oncology, Istituto di Ricovero e Cura a Carattere Scientifico and Unit of Urology, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Dehó
authors.affiliation: Urological Research Institute, Division of Experimental Oncology, Istituto di Ricovero e Cura a Carattere Scientifico and Unit of Urology, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Fossati
authors.affiliation: Urological Research Institute, Division of Experimental Oncology, Istituto di Ricovero e Cura a Carattere Scientifico and Unit of Urology, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Dell'Oglio
authors.affiliation: Department of Urology, Università degli studi e Spedali Civili di Brescia, Brescia, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Antonelli
authors.affiliation: Department of Urology, Università degli studi e Spedali Civili di Brescia, Brescia, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Furlan
authors.affiliation: Department of Urology, Università degli studi e Spedali Civili di Brescia, Brescia, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Simeone
authors.affiliation: Department of Urology, Clinica Urologica I, Azienda Ospedaliera Universitaria Careggi, Università degli studi di Firenze, Firenze, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Serni
authors.affiliation: Department of Urology, Clinica Urologica I, Azienda Ospedaliera Universitaria Careggi, Università degli studi di Firenze, Firenze, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Carini
authors.affiliation: Department of Urology, Clinica Urologica I, Azienda Ospedaliera Universitaria Careggi, Università degli studi di Firenze, Firenze, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Minervini
authors.affiliation: Department of Urology, Azienda Ospedaliero-Universitaria San Luigi Gonzaga, Università degli studi di Torino, Orbassano, Italy.
authors.forename: Cristian
authors.initials: C
authors.lastname: Fiori
authors.affiliation: Department of Urology, Azienda Ospedaliero-Universitaria San Luigi Gonzaga, Università degli studi di Torino, Orbassano, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Porpiglia
authors.affiliation: Urological Research Institute, Division of Experimental Oncology, Istituto di Ricovero e Cura a Carattere Scientifico and Unit of Urology, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Briganti
authors.affiliation: Urological Research Institute, Division of Experimental Oncology, Istituto di Ricovero e Cura a Carattere Scientifico and Unit of Urology, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.affiliation: Urological Research Institute, Division of Experimental Oncology, Istituto di Ricovero e Cura a Carattere Scientifico and Unit of Urology, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Bertini
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002423:Cause of Death / Q000639:trends; D017558:Elective Surgical Procedures / Q000379:methods*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D009399:Nephrons / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends
keywords: carcinoma, renal cell; cause of death; comorbidity; kidney; nephrectomy