A Prospective, Randomised EORTC Intergroup Phase 3 Study Comparing the Oncologic Outcome of Elective Nephron-Sparing Surgery and Radical Nephrectomy for Low-Stage Renal Cell Carcinoma

Poppel, Hendrik Van; Pozzo, L. Da; Albrecht, Walter; Matveev, Vsevolod; Bono, A.; Borkowski, Andrzej; Colombel, Marc; Klotz, Laurence; Skinner, Eila C.; Keane, Thomas E.; Marréaud, Sandrine; Collette, Sandra; Sylvester, Richard

doi:10.1016/j.eururo.2010.12.013

Cited by 950 publications

(590 citation statements)

References 26 publications

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“…Nephron-sparing surgery (NSS) has become the standard of care for the conservative management of clinically localized renal cell carcinoma (RCC) whenever technically feasible, 1,2 offering equivalent oncological results, 3,4 and less renal function impairment 5,6 compared with radical nephrectomy. The excision of the tumor with a minimal margin of healthy parenchyma surrounding the neoplasm is currently considered the standard technique for partial nephrectomy (PN), to minimize the risk of PSMs and achieve optimal local cancer control.…”

Section: Introductionmentioning

confidence: 99%

A Prospective, Multicenter Evaluation of Predictive Factors for Positive Surgical Margins After Nephron-Sparing Surgery for Renal Cell Carcinoma: The RECORd1 Italian Project

Schiavina

Serni

Mari

et al. 2015

Clinical Genitourinary Cancer

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The early oncological goal of any partial nephrectomy (PN) is to achieve negative surgical margins (SMs). Several factors have been advocated as predictors of positive SMs (PSMs) after nephron-sparing surgery (NSS). In our study, age, upper pole tumor location, standard PN and Fuhrman 3/4 nuclear grade were found to be independent predictors of PSMs at multivariable analysis. Further evaluations are required to verify the oncological effect of the PSM on local and systemic recurrence. Background: The purpose of this study was to evaluate the predictors of positive margins in one of the largest available prospective multi-institutional studies. Patients and Methods: We evaluated all patients who underwent NSS for radiologically diagnosed kidney tumors between January 2009 and December 2012 at 19 urological Italian centers (Registry of Conservative Renal Surgery [RECORd] project). Preoperative and anthropometric data, comorbidities, intraoperative and postoperative outcomes, and histological findings were analyzed. The negative and PSMs were compared according to the clinical and surgical variables. Multivariable logistic regression models were applied to analyze predictors of PSMs. Results: Eight hundred consecutive patients were evaluated. Seven hundred sixty-one (95.1%) and 39 patients (4.9%) achieved negative and PSMs, respectively. Patients with PSMs were significantly older compared with those with negative margins (median age: 66.6 vs. 61.8 years, respectively; P ¼ .001). A higher incidence of PSMs was observed when NSS was performed for renal masses located in the upper pole (P ¼ .001). A lower rate of PSMs was found in patients treated with simple enucleation rather than standard PN (1.6% vs. 7.4%, respectively; P < .0001). A greater incidence of PSMs was found in Fuhrman 3/4 tumors (11.3%; P < .0001). At multivariable analysis, age (odds ratio [OR], 1.04; P ¼ .01), upper pole tumor location (OR, 2.85; P ¼ .005), standard PN (OR, 3.45; P ¼ .004), and Fuhrman 3-4 nuclear grade (OR, 4.81; P ¼ .001) were found to be independent predictors of PSMs. Conclusion: In our multi-institutional report, young age, simple enucleation, middle or lower tumor location, and low-grade tumor were demonstrated to be independent predictors of negative SMs.

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Section: Introductionmentioning

confidence: 99%

A Prospective, Multicenter Evaluation of Predictive Factors for Positive Surgical Margins After Nephron-Sparing Surgery for Renal Cell Carcinoma: The RECORd1 Italian Project

Schiavina

Serni

Mari

et al. 2015

Clinical Genitourinary Cancer

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“…The conclusions were somewhat contradictory to the meta-analysis, revealing slightly better overall 10-year survival for RN (81.1%) than PN (75.7%) with an HR of 1.5 (95% CI, 1.03 to 2.16), which disappeared when considering only those diagnosed with RCC. 46 Oncologic outcomes were not different. 46 In the same meta-analysis, risk reduction of 61% for CKD was associated with PN 75 ; however, such renal benefits were not seen in the EORTC Trial.…”

Section: Clinicopathogic/pathologic Considerationsmentioning

confidence: 95%

“…46 Oncologic outcomes were not different. 46 In the same meta-analysis, risk reduction of 61% for CKD was associated with PN 75 ; however, such renal benefits were not seen in the EORTC Trial. 74 Surgically induced CKD has not been found to have the same cardiovascular morbidity or mortality typically as that seen 78 This discrepancy was attributed to changes in clinical practice patterns, where those with lower risk lesions were also being considered for PN in the modern cohort.…”

Section: Clinicopathogic/pathologic Considerationsmentioning

confidence: 95%

“…In fact, a patient with kidney cancer and a T1 tumor is much more likely to die of complications related to CKD than those related to their cancer. [45][46][47] With the possible exception of an adipose-rich angiomyolipoma, there are no clinical or radiologic features that can accurately predict the histologic subtype of a renal mass. Establishing the diagnosis has traditionally relied on the removal of the renal mass using radical nephrectomy (RN); however, newer renal sparing approaches are being used by urologists.…”

Section: Epidemiology Of Rccmentioning

confidence: 99%

“…Patients with SRMs are no longer dying primarily of kidney cancer, but rather, the RCC and CKD populations both have common risk factors, which predispose them to cardiovascular events and cardiovascular disease-related death. 46 Therefore, a greater focus of SRM treatment (T1a RCCs) should center on maximizing kidney function preservation, cardiovascular risk reduction, and long-term CKD care (Figure 2). A multidisciplinary team approach is necessary, involving the nephrologist, oncologist, pathologist, and urologist.…”

Section: Approach and Management Of Rccmentioning

confidence: 99%

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The Nephrologist’s Tumor: Basic Biology and Management of Renal Cell Carcinoma

Chang

Perazella

et al. 2016

JASN

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Kidney cancer, or renal cell carcinoma (RCC), is a disease of increasing incidence that is commonly seen in the general practice of nephrology. However, RCC is underrecognized by the nephrology community, such that its presence in curricula and research by this group is lacking. In the most common form of RCC, clear cell renal cell carcinoma (ccRCC), inactivation of the von Hippel-Lindau tumor suppressor is nearly universal; thus, the biology of ccRCC is characterized by activation of hypoxia-relevant pathways that lead to the associated paraneoplastic syndromes. Therefore, RCC is labeled the internist's tumor. In light of this characterization and multiple other metabolic abnormalities recently associated with ccRCC, it can now be viewed as a metabolic disease. In this review, we discuss the basic biology, pathology, and approaches for treatment of RCC. It is important to distinguish between kidney confinement and distant spread of RCC, because this difference affects diagnostic and therapeutic approaches and patient survival, and it is important to recognize the key interplay between RCC, RCC therapy, and CKD. Better understanding of all aspects of this disease will lead to optimal patient care and more recognition of an increasingly prevalent nephrologic disease, which we now appropriately label the nephrologist's tumor.

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Long-term Survival Following Partial vs Radical Nephrectomy Among Older Patients With Early-Stage Kidney Cancer

Tan

Norton²,

et al. 2012

JAMA

354

100

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Context Although partial nephrectomy is the preferred treatment for many patients with early-stage kidney cancer, recent clinical trial data, which demonstrate better survival for patients treated with radical nephrectomy, have generated new uncertainty regarding the comparative effectiveness of these treatment options.Objective To compare long-term survival after partial vs radical nephrectomy among a population-based patient cohort whose treatment reflects contemporary surgical practice. Design, Setting, and PatientsWe performed a retrospective cohort study of Medicare beneficiaries with clinical stage T1a kidney cancer treated with partial or radical nephrectomy from 1992 through 2007. Using an instrumental variable approach to account for measured and unmeasured differences between treatment groups, we fit a 2-stage residual inclusion model to estimate the treatment effect of partial nephrectomy on long-term survival. Main Outcome MeasuresOverall and kidney cancer-specific survival.Results Among 7138 Medicare beneficiaries with early-stage kidney cancer, we identified 1925 patients (27.0%) treated with partial nephrectomy and 5213 patients (73.0%) treated with radical nephrectomy. During a median follow-up of 62 months, 487 (25.3%) and 2164 (41.5%) patients died following partial or radical nephrectomy, respectively. Kidney cancer was the cause of death for 37 patients (1.9%) treated with partial nephrectomy, and 222 patients (4.3%) treated with radical nephrectomy. Patients treated with partial nephrectomy had a significantly lower risk of death (hazard ratio [HR], 0.54; 95% CI, 0.34-0.85). This corresponded with a predicted survival increase with partial nephrectomy of 5.6 (95% CI, 1.9-9.3), 11.8 (95% CI, 3.9-19.7), and 15.5 (95% CI, 5.0-26.0) percentage points at 2, 5, and 8 years posttreatment (PϽ.001). No difference was noted in kidney cancer-specific survival (HR, 0.82; 95% CI, 0.19-3.49). ConclusionAmong Medicare beneficiaries with early-stage kidney cancer who were candidates for either surgery, treatment with partial rather than radical nephrectomy was associated with improved survival.

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A Prospective, Randomised EORTC Intergroup Phase 3 Study Comparing the Oncologic Outcome of Elective Nephron-Sparing Surgery and Radical Nephrectomy for Low-Stage Renal Cell Carcinoma

Cited by 950 publications

References 26 publications

A Prospective, Multicenter Evaluation of Predictive Factors for Positive Surgical Margins After Nephron-Sparing Surgery for Renal Cell Carcinoma: The RECORd1 Italian Project

A Prospective, Multicenter Evaluation of Predictive Factors for Positive Surgical Margins After Nephron-Sparing Surgery for Renal Cell Carcinoma: The RECORd1 Italian Project

The Nephrologist’s Tumor: Basic Biology and Management of Renal Cell Carcinoma

Long-term Survival Following Partial vs Radical Nephrectomy Among Older Patients With Early-Stage Kidney Cancer

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