Survival outcomes after radical and partial nephrectomy for clinical T2 renal tumours categorised by R.E.N.A.L. nephrometry score. (3rd October 2014)

• Record Type: Journal Article
• Authors: 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.
• Is Part Of: BJU international. Volume 114:Number 5(2014:Nov.)
• Page Start: 708
• Page End: 718
• Publication Date: 2014-10-03
• Subjects: Genitourinary organs -- Diseases -- Periodicals; Genitourinary organs -- Surgery -- Periodicals; Urology -- Periodicals; 616.6
• DOI: 10.1111/bju.12580
• Languages: English
• ISSNs: 1464-4096

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bju12580-sec-0001" sec-type="section"> <title>Objective</title> <p>We evaluated survival outcomes of partial nephrectomy (PN) and radical nephrectomy (RN) for clinical T2 renal masses (cT2RM) controlling for R.E.N.A.L. nephrometry score.</p> </sec> <sec id="bju12580-sec-0002" sec-type="section"> <title>Patients and Methods</title> <p>A two‐centre study comprised of 202 patients with cT2RM who underwent RN (122) or PN (80) between July 2002 and June 2012 (median follow‐up 41.5 months). Kaplan−Meier 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 Cox‐proportional hazard.</p> </sec> <sec id="bju12580-sec-0003" sec-type="section"> <title>Results</title> <p>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% (<italic>P</italic> = 0.115), CSS was 82.5% and 86.7% (<italic>P</italic> = 0.407), and OS was 80% and 83.3% (<italic>P</italic> = 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, <italic>P</italic> = 0.002). Kaplan–Meier 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 (<italic>P</italic> < 0.001) and for cT2a vs cT2b tumours (<italic>P</italic> = 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 (<italic>P</italic> < 0.001) or any cause (<italic>P</italic> < 0.001) vs those with R.E.N.A.L. nephrometry scores of <10.</p> </sec> <sec id="bju12580-sec-0004" sec-type="section"> <title>Conclusions</title> <p>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.</p> </sec> </abstract>