Partial Nephrectomy Is Associated with Improved Overall Survival
Compared to Radical Nephrectomy in Patients with Unanticipated
Benign Renal Tumours
Christopher J. Weight, Gregory Lieser, Benjamin T. Larson, Tianming Gao, Brian R. Lane,
Steven C. Campbell, Inderbir S. Gill, Andrew C. Novick, Amr F. Fergany*
Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
EUROPEAN UROL OG Y 58 (2010) 293–298
available at www.sciencedirect.com
journal homepage: www.europeanurology.com
Accepted April 29, 2010
Published online ahead of
print on May 18, 2010
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Background: Partial nephrectomy (PN) has been associated with improved overall
survival (OS) in select cohorts with localised renal masses when compared to radical
nephrectomy (RN). The driving forces behind these differences have been difficult to
elucidate given the heterogeneity of previously compared cohorts.
Objective: Compare OS in a subset of patients with unanticipated benign renal
masses to minimise the confounding effect of cancer.
Design, setting, and participants: We retrospectively evaluated 2608 consecutive
clinical T1 enhancing renal masses that were treated with extirpative surgery at our
institution between 1999 and 2006. Of these, 499 tumours (19%) were found to be
benign on final pathology. Preoperative data and renal functional data were used to
generate a propensity model that was then plugged into a multivariate model of
survival. Median follow-up fortheentire cohort was 50 mo (interquartile range [IQR]:
Intervention: All patients underwent PN or RN.
Measurements: We measured OS and cardiac-specific survival.
Results and limitations: Five-year OS estimates for the PN (n = 388) and RN (n = 111)
cohorts were 95% (95% confidence interval [CI], 93–98) versus 83% (95% CI, 74–90),
respectively (P < 0.0001). On multivariate analysis, controlling for both comorbidity
and age, RN was associated with a 2.5-fold increased risk of death compared to PN
(hazard ratio [HR]: 2.5; 95% CI, 1.3–5.1). Postoperativeestimated glomerular filtration
rate(eGFR) was also anindependentpredictor ofOSandcardiac-specificsurvival(HR:
nature of this analysis limits the strength of the conclusions.
Conclusions: PN was associated with better OS when compared to RN in patients
with unanticipated benign tumours. This observed survival advantage appears partly
to be the result of better preservation of eGFR, but other kidney functions or
unmeasured factors may also play a role. These data indicate that PN should be
aggressively pursued in any patient where PN is technically feasible.
# 2010 European Association of Urology. Published by Elsevier B.V. All rights reserved.
Cleveland, OH 44195, USA. Tel. +216 444 0414.
E-mail address: Fergana@ccf.org (A.F. Fergany).
0302-2838/$ – see back matter # 2010 European Association of Urology. Published by Elsevier B.V. All rights reserved.doi:10.1016/j.eururo.2010.04.033
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