Overall survival and oncological outcomes after partial nephrectomy and radical nephrectomy for cT2a renal tumors: A collaborative international study from the French kidney cancer research network UroCCR
2018
Reix, B. | Bernhard, J.-C. | Patard, J.-J. | Bigot, P. | Villers, A. | Suer, E. | Vuong, N. S. | Verhoest, G. | Alimi, Q. | Beauval, J.-B. | Benoit, T. | Nouhaud, F.-X. | Lenormand, C. | Hamidi, N. | Cai, J. | Eto, M. | Larre, S. | El Bakhri, A. | Ploussard, G. | Hung, A. | Koutlidis, N. | Schneider, A. | Carrouget, J. | Droupy, S. | Marchal, S. | Doerfler, A. | Seddik, S. | Matsugasumi, T. | Orsoni, X. | Descazeaud, A. | Pfister, C. | Bensalah, K. | Soulie, M. | Gill, I. | Flamand, V. | Ccafu, Kidney Cancer, Group of The | Centre Hospitalier Régional Universitaire [CHU Lille] (CHRU Lille) | Service d'urologie, andrologie et transplantation rénale ; Université Bordeaux Segalen - Bordeaux 2-Centre Hospitalier Universitaire de Bordeaux (CHU Bordeaux)-Groupe hospitalier Pellegrin | Institut de Génétique et Développement de Rennes (IGDR) ; Université de Rennes (UR)-Centre National de la Recherche Scientifique (CNRS)-Structure Fédérative de Recherche en Biologie et Santé de Rennes (Biosit : Biologie - Santé - Innovation Technologique) | Centre Hospitalier Universitaire d'Angers (CHU Angers) ; PRES Université Nantes Angers Le Mans (UNAM) | Centre d'Études Biologiques de Chizé - UMR 7372 (CEBC) ; Institut National de la Recherche Agronomique (INRA)-La Rochelle Université (ULR)-Centre National de la Recherche Scientifique (CNRS) | Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Pontchaillou] | Institut Universitaire du Cancer de Toulouse - Oncopole (IUCT Oncopole - UMR 1037) ; Université Toulouse III - Paul Sabatier (UT3) ; Université de Toulouse (UT)-Université de Toulouse (UT)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Institut National de la Santé et de la Recherche Médicale (INSERM) | Service d'urologie [CHU Rouen] ; CHU Rouen ; Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN) ; Normandie Université (NU) | CHU Rouen ; Normandie Université (NU) | Institut de recherches sur la catalyse et l'environnement de Lyon (IRCELYON) ; Université Claude Bernard Lyon 1 (UCBL) ; Université de Lyon-Université de Lyon-Institut de Chimie - CNRS Chimie (INC-CNRS)-Centre National de la Recherche Scientifique (CNRS) | Hôpital universitaire Robert Debré [Reims] (CHU Reims) | CHU Dijon ; Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon) | Terres Inovia | Centre Hospitalier Universitaire de Nîmes (CHU Nîmes) | Université de Montpellier (UM) | Service d'Urologie [CHU Caen] ; Université de Caen Normandie (UNICAEN) ; Normandie Université (NU)-Normandie Université (NU)-CHU Caen Normandie – Centre Hospitalier Universitaire de Caen Normandie (CHU Caen Normandie) ; Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN) | Service de Chirurgie urologique et andrologie [CHU Limoges] ; CHU Limoges | Centre Hospitalier Universitaire de Toulouse (CHU Toulouse) | Université Lille Nord de France (COMUE)
International audience
Mostrar más [+] Menos [-]Inglés. BACKGROUND: Partial nephrectomy (PN) is recommended as first-line treatment for cT1 stage kidney tumors because of a better renal function and probably a better overall survival than radical nephrectomy (RN). For larger tumors, PN has a controversial position due to lack of evidence showing good cancer control. The aim of this study was to compare the results of PN and RN in cT2a stage on overall survival and oncological results. METHOD: A retrospective international multicenter study was conducted in the frame of the French kidney cancer research network (UroCCR). We considered all patients aged>=18 years who underwent surgical treatment for localized renal cell carcinoma (RCC) stage cT2a (7.1-10cm) between 2000 and 2014. Cox and Fine-Gray models were performed to analyze overall survival (OS), cancer specific survival (CSS) and cancer-free survival (CFS). Comparison between PN and RN was realized after an adjustment by propensity score considering predefined confounding factors: age, sex, tumor size, pT stage of the TNM classification, histological type, ISUP grade, ASA score. RESULTS: A total of 267 patients were included. OS at 3 and 5 years was 93.6% and 78.7% after PN and 88.0% and 76.2% after RN, respectively. CSS at 3 and 5 years was 95.4% and 80.2% after PN and 91.0% and 85.0% after RN. No significant difference between groups was found after propensity score adjustment for OS (HR 0.87, 95% CI: 0.37-2.05, P=0.75), CSS (HR 0.52, 95% CI: 0.18-1.54, P=0.24) and CFS (HR 1.02, 95% CI: 0.50-2.09, P=0.96). CONCLUSION: PN seems equivalent to RN for OS, CSS and CFS in cT2a stage kidney tumors. The risk of recurrence is probably more related to prognostic factors than the surgical technique. The decision to perform a PN should depend on technical feasibility rather than tumor size, both to imperative and elective situation. LEVEL OF EVIDENCE: 4.
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