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Should patients with low‐risk renal cell carcinoma be followed differently after nephron‐sparing surgery vs radical nephrectomy?
Author(s) -
AbuGhanem Yasmin,
Powles Thomas,
Capitanio Umberto,
Beisland Christian,
Järvinen Petrus,
Stewart Grant D.,
Gudmundsson Eirikur,
Lam Thomas B.L.,
Marconi Lorenzo,
FernandézPello Sergio,
Nisen Harry,
Meijer Richard P.,
Volpe Alessandro,
Ljungberg Börje,
Klatte Tobias,
Bensalah Karim,
Dabestani Saeed,
Bex Axel
Publication year - 2021
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.15415
Subject(s) - medicine , nephrectomy , hazard ratio , renal cell carcinoma , confidence interval , retrospective cohort study , multivariate analysis , urology , proportional hazards model , kidney cancer , univariate analysis , surgery , carcinoma , gastroenterology , oncology , kidney
Objective To investigate whether pT1 renal cell carcinoma (RCC) should be followed differently after partial (PN) or radical nephrectomy (RN) based on a retrospective analysis of a multicentre database (RECUR). Subjects A retrospective study was conducted in 3380 patients treated for nonmetastatic RCC between January 2006 and December 2011 across 15 centres from 10 countries, as part of the RECUR database project. For patients with pT1 clear‐cell RCC, patterns of recurrence were compared between RN and PN according to recurrence site. Univariate and multivariate models were used to evaluate the association between surgical approach and recurrence‐free survival (RFS) and cancer‐specific mortality (CSM). Results From the database 1995 patients were identified as low‐risk patients (pT1, pN0, pNx), of whom 1055 (52.9%) underwent PN. On multivariate analysis, features associated with worse RFS included tumour size (hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.14–1.39; P < 0.001), nuclear grade (HR 2.31, 95% CI 1.73–3.08; P < 0.001), tumour necrosis (HR 1.5, 95% CI 1.03–2.3; P = 0.037), vascular invasion (HR 2.4, 95% CI 1.3–4.4; P = 0.005) and positive surgical margins (HR 4.4, 95% CI 2.3–8.5; P < 0.001). Kaplan–Meier analysis of CSM revealed that the survival of patients with recurrence after PN was significantly better than those with recurrence after RN ( P = 0.02). While the above‐mentioned risk factors were associated with prognosis, type of surgery alone was not an independent prognostic variable for RFS nor CSM. Limitations include the retrospective nature of the study. Conclusion Our results showed that follow‐up protocols should not rely solely on stage and type of primary surgery. An optimized regimen should also include validated risk factors rather than type of surgery alone to select the best imaging method and to avoid unnecessary imaging. A follow‐up of more than 3 years should be considered in patients with pT1 tumours after RN. A novel follow‐up strategy is proposed.