Comparison of Partial and Radical Nephrectomy for pT1b Renal Cell Carcinoma

Kim, Jong Min; Song, Phil Hyun; Kim, Hyun Tae; Park, Tong Choon

doi:10.4111/kju.2010.51.9.596

Cited by 23 publications

(14 citation statements)

References 23 publications

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“…The main advantage of PN includes maximal preservation of renal parenchyma, which helps to avoid end-stage renal disease [19], [20]. There was no clear evidence that PN was associated with an inferior oncological outcome with stage T1a-T1b or even T2 cancer [4], [5].…”

Section: Discussionmentioning

confidence: 99%

Ischemic Preconditioning Increases Endothelial Progenitor Cell Number to Attenuate Partial Nephrectomy-Induced Ischemia/Reperfusion Injury

Líu

Jia

et al. 2013

PLoS ONE

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ObjectivesThe objective of this study was to investigate the role of endothelial progenitor cells (EPCs) in the modulation of ischemia-reperfusion injury (IRI) in a partial nephrectomy (PN) rat model using early-phase ischemic preconditioning (IPC).Materials and MethodsNinety male Sprague-Dawley rats were randomly divided into three groups following right-side nephrectomy: Sham-operated rats (surgery without vascular clamping); PN rats (renal blood vessels were clamped for 40 min and PN was performed); and IPC rats (pretreated with 15 min ischemia and 10 min reperfusion). At 1, 3, 6, 12, 24 h, and 3 days after reperfusion, the pool of circulating EPCs and kidneys were harvested. The extent of renal injury was assessed, along with EPC number, cell proliferation, angiogenesis, and vascular growth factor expression.ResultsPretreated rats exhibited significant improvements in renal function and morphology. EPC numbers in the kidneys were increased at 12 h following reperfusion in the IPC group as compared to the PN or Sham groups. Cell proliferation (including endothelial and tubular epithelial cells) and angiogenesis in peritubular capillaries were markedly increased in kidneys treated with IPC. In addition, vascular endothelial growth factor-A (VEGF-A) and stromal cell-derived factor-1α (SDF-1α) expression in the kidneys of pretreated rats was increased compared to rats subjected to PN.ConclusionsOur investigation suggested that: (1) the early phase of IPC may attenuate renal IRI induced by PN; (2) EPCs play an important role in renal protection, involving promotion of cell proliferation and angiogenesis through release of several angiogenic factors.

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Section: Discussionmentioning

confidence: 99%

Ischemic Preconditioning Increases Endothelial Progenitor Cell Number to Attenuate Partial Nephrectomy-Induced Ischemia/Reperfusion Injury

Líu

Jia

et al. 2013

PLoS ONE

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“…Several antecedent studies have indicated PN might be safely expanded to include patients with T1bN0M0 tumours [5,21–23]. In fact, as it pertains to these patients, Leibovich et al .…”

Section: Discussionmentioning

confidence: 99%

Survival after partial and radical nephrectomy for the treatment of stage T1bN0M0 renal cell carcinoma (RCC) in the USA: a propensity scoring approach

et al. 2011

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Study Type – Therapy (cohort) Level of Evidence 2b What's known on the subject? and What does the study add? Partial nephrectomy has become the standard of care for T1a renal tumours, and the application of nephron‐sparing techniques has increasingly been expanded to patients with localized T1b cancers. However, the relative efficacy of partial versus radical nephrectomy for these medium‐sized tumours has yet to be definitively established. This study employs a propensity scoring approach within a large US population‐based cohort to determine that no survival differences exist among patients with T1b renal tumours undergoing partial versus radical nephrectomy. OBJECTIVES To compare survival after partial nephrectomy (PN) vs radical nephrectomy (RN) among patients with stage TIb renal cell carcinoma (RCC) using a propensity scoring approach. Propensity score analysis is a statistical methodology that controls for non‐random assignment of patients in observational studies. PATIENTS AND METHODS Using the Surveillance, Epidemiology, and End Results registry, 11 256 cases of RCCs of 4–7 cm that underwent PN or RN between 1998 and 2007 were identified. Propensity score analysis was used to adjust for potential differences in baseline characteristics between patients in the two treatment groups. Overall survival (OS) and cancer‐specific survival (CSS) of patients undergoing PN vs RN was compared in stratified and adjusted analysis, controlling for propensity scores. RESULTS In all, 1047 (9.3%) patients underwent PN. For the entire cohort, no difference in survival was found in patients treated with PN as compared with RN, as shown by the adjusted hazard ratio (HR) for OS (1.10; 95% confidence interval [CI]: 0.91–1.36) and renal‐CSS (HR 0.91; 95% CI: 0.65–1.27). When the cohort was stratified by tumour size and age, no difference in survival was identified between the groups. CONCLUSIONS Even when stratified by tumour size and age, a survival difference between PN and RN in a propensity‐adjusted cohort of patients with T1b RCC could not be confirmed. If validated in prospective studies, PN may become the preferred treatment for T1b renal tumours in centres experienced with nephron‐sparing surgery.

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“…In fact, several antecedent investigations have indicated partial nephrectomy can safely be expanded to include patients with T1bN0M0 tumors. (Becker et al, 2006a;Kim et al, 2010;Mitchell et al, 2006;Patard et al, 2004) Leibovich and colleagues reported cancer-specific survival rates at 5 years of 98% for those receiving nephron-sparing surgery and 86% for patients treated with radical nehrectomy; and, after adjusting for several covariates including tumor grade and histologic subtype, this difference was found to no longer be statistically significant (risk ratio 1.60, 95% CI 0.50-5.12, p=0.430). (Leibovich et al, 2004) In a similar vein, Patard et al noted that 3 year disease-specific survival rates were comparable at 98% and 97% (p=0.8) when partial nephrectomy patients were stratified by tumor size less than and greater than 4cm, respectively.…”

Section: Partial Nephrectomy Is Increasingly Being Utilized In Mediummentioning

confidence: 99%

Renal Cortical Neoplasms and Associated Renal Functional Outcomes

Badalato¹,

Kates²,

Sadeghi³

et al. 2012

Diseases of Renal Parenchyma

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Comparison of Partial and Radical Nephrectomy for pT1b Renal Cell Carcinoma

Cited by 23 publications

References 23 publications

Ischemic Preconditioning Increases Endothelial Progenitor Cell Number to Attenuate Partial Nephrectomy-Induced Ischemia/Reperfusion Injury

Ischemic Preconditioning Increases Endothelial Progenitor Cell Number to Attenuate Partial Nephrectomy-Induced Ischemia/Reperfusion Injury

Survival after partial and radical nephrectomy for the treatment of stage T1bN0M0 renal cell carcinoma (RCC) in the USA: a propensity scoring approach

Renal Cortical Neoplasms and Associated Renal Functional Outcomes

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