title: Disease progression and kidney function after partial vs. radical nephrectomy for T1 renal cancer.
abstract: Partial nephrectomy (PN) for early stage renal cancer preserves renal function better than radical nephrectomy (RN) and is generally considered oncologically similar. The Intergroup European Organisation for Research and Treatment of Cancer trial comparing outcomes after PN vs. RN, however, showed reduced overall survival in the PN group. Our aim was to evaluate recurrence, death, and renal function after PN vs. RN for T1 tumors in a Canadian population.
  
  
  
  From 2000 to 2015, 2,358 patients with a first occurrence of a clinical T1 renal cancer who underwent PN or RN were identified from the Canadian Kidney Cancer Information System. Clinical, surgical, and pathologic parameters were analyzed. Time to progression was compared after PN vs. RN using a Cox proportional hazards model, adjusted for pertinent variables.
  
  
  
  Inclusion criteria were met in 1,615 PN and 743 RN. Preoperative characteristics appeared similar in both groups. Time to progression was not different after PN vs. RN, adjusted for potential confounders (hazard ratio = 1.17 [95% CI: 0.8-1.72, P = 0.42]). Postoperative estimated glomerular filtration rate at 1 and 3 years was significantly greater for PN vs. RN in a linear regression model, accounting for preoperative estimated glomerular filtration rate.
  
  
  
  These results suggest that progression-free survival after PN and RN in patients with T1 renal cancer was similar, but that there was better preservation of renal function after PN. This suggests that both PN and RN have similar oncological efficiency, and that selection of surgical approach should be based on other factors such as technical feasibility, potential complications, and preservation of renal function.
authors.affiliation: Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Connor M
authors.initials: CM
authors.lastname: Forbes
authors.affiliation: Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Ricardo A
authors.initials: RA
authors.lastname: Rendon
authors.affiliation: Department of Surgery (Urology), Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada.
authors.forename: Antonio
authors.initials: A
authors.lastname: Finelli
authors.affiliation: Division of Urology, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Anil
authors.initials: A
authors.lastname: Kapoor
authors.affiliation: Department of Urology, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Ronald B
authors.initials: RB
authors.lastname: Moore
authors.affiliation: Division of Urology, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Rodney H
authors.initials: RH
authors.lastname: Breau
authors.affiliation: Department of Surgery (Urology), Laval University, Quebec City, Quebec, Canada.
authors.forename: Louis
authors.initials: L
authors.lastname: Lacombe
authors.affiliation: Division of Urology, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Jun
authors.initials: J
authors.lastname: Kawakami
authors.affiliation: Section of Urology, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Darrel E
authors.initials: DE
authors.lastname: Drachenberg
authors.affiliation: Division of Urology, Western University, London, Ontario, Canada.
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Pautler
authors.affiliation: Department of Surgery (Urology), Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada.
authors.forename: Michael M A
authors.initials: MMA
authors.lastname: Jewett
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Olli
authors.initials: O
authors.lastname: Saarela
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Zhihui
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Division of Urology, McGill University, Montreal, Québec, Canada.
authors.forename: Simon
authors.initials: S
authors.lastname: Tanguay
authors.affiliation: Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: pblack@mail.ubc.ca.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Black
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D015986:Confounding Factors, Epidemiologic; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology*; D007680:Kidney Neoplasms / Q000503:physiopathology / Q000601:surgery*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods*; D016016:Proportional Hazards Models; D055815:Young Adult
keywords: Kidney cancer; Partial nephrectomy; Progression; Radial nephrectomy; Recurrence; Renal cancer; Survival