Comparative Effectiveness for Survival and Renal Function of Partial and Radical Nephrectomy for Localized Renal Tumors: A Systematic Review and Meta-Analysis

Kim, Simon P.; Murad, M. Hassan; Thompson, R. Houston; Boorjian, Stephen A.; Weight, Christopher J.; Han, Leona C.; Erwin, Patricia J.; Costello, Brian A.; Chow, George K.; Leibovich, Bradley C.

doi:10.1016/j.juro.2012.10.026

Cited by 111 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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“…Nephron-sparing procedures, including partial nephrectomy (PN) and ablative therapies, are emerging as mainstream therapies for SRMs, because accumulating evidence has shown comparable oncologic and overall survival and greater renal preservation. 64,74,75 Moreover, many cohort studies showed a survival advantage and greater GFR preservation with PN. 75 Correspondingly, a meta-analysis evaluated findings across 36 studies (mostly retrospective cohort studies) including 40,000 patients (31,000 RN and 9300 PN) and found that treatment of SRMs with PN conferred a 19% risk reduction for all-cause mortality and a 29% risk reduction for cancer-specific mortality.…”

Section: Clinicopathogic/pathologic Considerationsmentioning

confidence: 99%

“…64,74,75 Moreover, many cohort studies showed a survival advantage and greater GFR preservation with PN. 75 Correspondingly, a meta-analysis evaluated findings across 36 studies (mostly retrospective cohort studies) including 40,000 patients (31,000 RN and 9300 PN) and found that treatment of SRMs with PN conferred a 19% risk reduction for all-cause mortality and a 29% risk reduction for cancer-specific mortality. 75 This included one randomized, controlled trial the European Organization for Research and Treatment of Cancer (EORTC) study of 541 patients with solitary unilateral SRMs (#5 cm).…”

Section: Clinicopathogic/pathologic Considerationsmentioning

confidence: 99%

“…75 Correspondingly, a meta-analysis evaluated findings across 36 studies (mostly retrospective cohort studies) including 40,000 patients (31,000 RN and 9300 PN) and found that treatment of SRMs with PN conferred a 19% risk reduction for all-cause mortality and a 29% risk reduction for cancer-specific mortality. 75 This included one randomized, controlled trial the European Organization for Research and Treatment of Cancer (EORTC) study of 541 patients with solitary unilateral SRMs (#5 cm). 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.…”

Section: Clinicopathogic/pathologic Considerationsmentioning

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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“…This trend has been attributed to the growing number of small renal masses incidentally detected on cross-sectional imaging performed for non-urologic conditions [3]. With this trend, treatment with partial nephrectomy (PN) has seen widespread use [4][5][6] as a means to avoid the sequelae of surgically induced chronic kidney disease associated with radical nephrectomy (RN) [7][8][9][10]. In fact, current guidelines from the American Urological Association (AUA) [11], National Comprehensive Cancer Network (NCCN) [12••], and European Association of Urology (EUA) [13••] now promote the use of PN whenever technically feasible for the treatment of small renal tumors.…”

Section: Introductionmentioning

confidence: 99%

Post Partial Nephrectomy Surveillance Imaging: an Evidence-Based Approach

Gorin

Allaf

2015

Curr Urol Rep

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To ensure the early detection of recurrent disease, all patients should undergo routine surveillance following partial nephrectomy for renal cell carcinoma. In order to optimize resource allocation and avoid unnecessary radiation exposure, the frequency and duration of surveillance should be tailored to the individual patient's risk of cancer recurrence. The evidence for surveillance after partial nephrectomy is presented reviewing the current literature on prognostic models and proposed surveillance protocols based on the timing and patterns of renal cell carcinoma recurrence. In addition, we review recent guidelines on post partial nephrectomy surveillance as well as the literature on novel imaging techniques that may aid in early disease discovery.

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Comparative Effectiveness for Survival and Renal Function of Partial and Radical Nephrectomy for Localized Renal Tumors: A Systematic Review and Meta-Analysis

Cited by 111 publications

References 0 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

Post Partial Nephrectomy Surveillance Imaging: an Evidence-Based Approach

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