Partial versus Radical Nephrectomy for T1-T2 Renal Cell Carcinoma in Patients with Chronic Kidney Disease Stage III: a Multiinstitutional Analysis of Kidney Function and Survival Rate.
10.3346/jkms.2018.33.e277
- Author:
Jae Seung CHUNG
1
;
Nak Hoon SON
;
Sang Eun LEE
;
Sung Kyu HONG
;
Chang Wook JEONG
;
Cheol KWAK
;
Hyeon Hoe KIM
;
Sung Hoo HONG
;
Yong June KIM
;
Seok Ho KANG
;
Jinsoo CHUNG
;
Tae Gyun KWON
;
Eu Chang HWANG
;
Seok Soo BYUN
Author Information
1. Department of Urology, Inje University Haeundae Paik Hospital, Busan, Korea.
- Publication Type:Original Article
- Keywords:
Carcinoma, Renal Cell;
Survival;
Nephrectomy;
Renal Insufficiency
- MeSH:
Carcinoma, Renal Cell*;
Humans;
Kidney*;
Methods;
Nephrectomy*;
Renal Insufficiency;
Renal Insufficiency, Chronic*;
Survival Rate*
- From:Journal of Korean Medical Science
2018;33(43):e277-
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: To examine survival rates and renal function after partial nephrectomy (PN) and radical nephrectomy (RN) in patients with chronic kidney disease (CKD). METHODS: We studied 4,332 patients who underwent PN or RN for pathological T1a-T2N0M0 renal cell carcinoma from 1988 to 2014. Patients were divided into two subgroups of CKD stage I–II and stage III. Kidney function, and survival outcomes were compared between groups. RESULTS: We included 1,756 patients with CKD I–II and 276 patients with CKD III in the final pair-matched analysis. Kidney function was significantly better preserved in the PN than in the RN group among all patients. However, the beneficial effect of PN on kidney function gradually disappeared over time in CKD III patients. The 5-year overall survival (OS) rates after PN and RN differed in patients with CKD I–II disease (99.4% vs. 96.5%, respectively, P = 0.015). The 5-year OS rates after surgery were not affected by mode of nephrectomy in CKD III patients (97.8% vs. 93.5%, P = 0.103). The 5-year cancer-specific survival rates did not differ between treatment groups in all CKD stage. Cox hazard analysis showed that the operative method was a significant factor for OS in CKD I–II patients (hazard ratio [HR], 0.320; confidence interval [CI], 0.122–0.840; P = 0.021). However, PN was not beneficial in terms of OS in CKD III patients (HR, 0.395; CI, 0.086–1.172; P = 0.117). CONCLUSION: PN is associated with a higher OS rate and better kidney function in patients with preoperative CKD stage I and II, but not in those with CKD stage III.
