Journal
BJU INTERNATIONAL
Volume 102, Issue 11, Pages 1610-1614Publisher
WILEY
DOI: 10.1111/j.1464-410X.2008.07917.x
Keywords
kidney neoplasm; natural history; renal cell carcinoma; conservative management; cancer-specific survival; locally advanced stage
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Funding
- University of Montreal Health Center Urology Associated, Fonds de la Recherche en SantE du Quebec
- University of Montreal Department Of Surgery and the University of Montreal Health Center (CHUM) Foundation
- Association Francaise de Recherche sur le Cancer
- Fondation de France-Federation Nationale des Centres de Lutte Contre le Cancer
- Association FranAaise d'Urologie and the MinistEre Francais des Affaires EtrangEres et Europeennes ( Bourse Lavoisier)
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To examine the cancer-specific survival of patients treated with nephrectomy and compared it to that of patients managed without surgery. Of 43 143 patients with renal cell carcinoma (RCC) identified in the 1988-2004 Surveillance, Epidemiology and End Results database, 7068 had locally advanced RCC and with no distant metastasis. These patients had a nephrectomy (6786, 96.0%) or no surgical therapy (282, 4.0%). Multivariable Cox regression models, and matched and unmatched Kaplan-Meier survival analyses, were used to compare the effect of nephrectomy vs non-surgical therapy on cancer-specific survival. Also, competing-risks regression models adjusted for the effect of other-cause mortality. Covariates and matching variables consisted of age, gender, tumour size and year of diagnosis. The 1-, 2-, 5- and 10-year cancer-specific survival of patients who had nephrectomy was 88.9%, 88.1%, 68.6% and 57.5%, vs 44.8%, 30.6%, 14.5% and 10.6% for non-surgical therapy. In multivariable analyses, relative to nephrectomy, non-surgical therapy was associated with a 5.8-fold higher rate of cancer-specific mortality (P < 0.001). Non-surgical therapy was also associated with a 5.1-fold higher rate of cancer-specific mortality in matched analyses (P < 0.001). Finally, competing-risks regression confirmed the statistical significance of the variable defining treatment type (nephrectomy vs non-surgical therapy) in multivariable and matched analyses (P < 0.001). Relative to non-surgical treatment, nephrectomy improves the cancer-specific survival of patients with locally advanced RCC; our findings await prospective confirmation.
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