Premium
Survival outcomes after radical and partial nephrectomy for clinical T 2 renal tumours categorised by R . E . N . A . L . nephrometry score
Author(s) -
Kopp Ryan P.,
Mehrazin Reza,
Palazzi Kerrin L.,
Liss Michael A.,
Jabaji Ramzi,
Mirheydar Hossein S.,
Lee Hak J.,
Patel Nishant,
Elkhoury Fuad,
Patterson Anthony L.,
Derweesh Ithaar H.
Publication year - 2014
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.12580
Subject(s) - nephrectomy , medicine , hazard ratio , urology , proportional hazards model , cohort , overall survival , gastroenterology , kidney , confidence interval
Objective We evaluated survival outcomes of partial nephrectomy ( PN ) and radical nephrectomy ( RN ) for clinical T 2 renal masses ( cT2RM ) controlling for R . E . N . A . L . nephrometry score. Patients and Methods A two‐centre study comprised of 202 patients with cT2RM who underwent RN (122) or PN (80) between J uly 2002 and J une 2012 (median follow‐up 41.5 months). Kaplan− M eier analysis compared overall survival ( OS ), cancer‐specific survival ( CSS ) and progression‐free survival ( PFS ) among the entire cohort and within categories of R . E . N . A . L . nephrometry score of ≥10 and <10. Association between procedure and PFS and OS was analysed using C ox‐proportional hazard. Results There were no significant differences between PN and RN in clinical T stage and R . E . N . A . L . nephrometry scores. For RN and PN , the 5‐year PFS was 69.8% and 79.9% ( P = 0.115), CSS was 82.5% and 86.7% ( P = 0.407), and OS was 80% and 83.3% ( P = 0.291). Cox regression showed no association between RN vs PN and PFS ; a R . E . N . A . L . nephrometry score of ≥10 was associated with a shorter PFS (hazard ratio 6.69, P = 0.002). Kaplan– M eier analysis for RN vs PN showed no difference in PFS for entire cohort or within the R . E . N . A . L . nephrometry score categories of ≥10 and <10. The PFS was better for those with R . E . N . A . L nephrometry scores of <10 vs ≥10 ( P < 0.001) and for cT2a vs cT2b tumours ( P = 0.012). OS was no different between cT2a and cT2b tumours; patients with R . E . N . A . L . nephrometry scores of ≥10 were more likely to die from disease ( P < 0.001) or any cause ( P < 0.001) vs those with R . E . N . A . L . nephrometry scores of <10. Conclusions PN may be oncologically effective for cT2RM . A R . E . N . A . L nephrometry score of ≥10 is negatively associated with OS among cT2RM compared with a score of <10 and provides additional risk assessment beyond clinical T stage. Further follow‐up and prospective randomised investigation is requisite to confirm efficacy of PN for cT2RM .