STOCKHOLM, SWEDEN (UroToday.com) - In patients with small renal masses, nephron-sparing surgery (NSS) may improve all-cause mortality when compared to radical nephrectomy (RN). However, numerous prior studies attempting to analyze the survival benefit of NSS are plagued by selection bias and the inability to completely control for confounding characteristics. Dr. U. Capitanio and colleagues tested the effect of treatment type (NSS vs RN) on survival following adjustment for clinical characteristics, comorbidities, and individual cardiovascular risk. A total of 2 685 patients, with clinical T1a-T1b renal mass, from 4 tertiary care centers in Europe underwent RN (39.4%) or NSS (60.6%). Among all patients, eGFR was normal prior to surgery.
After a median follow-up of 61 months, 5- and 10-year other-cause mortality rates after NSS were 5.2% and 13.2% vs 7.4% and 15.1% following RN, respectively. Following multivariable analysis, patients treated with PN showed similar risk to die of other-cause mortality compared with their RN-treated counterparts (HR 0.77). Increasing age (HR 1.1), Charlson Comorbidity Index (HR 1.2), and tobacco use (HR 1.9) were independent predictors of other-cause mortality. Following adjustment for comorbidity and competing risks, NSS does not appear to decrease other-cause mortality relative to RN among the patients examined.
Presented by U. Capitanio at the 29th Annual European Association of Urology (EAU) Congress - April 11 - 15, 2014 - Stockholmsmässan - Stockholm, Sweden.
San Raffaele Scientific Institute, Department of Urology, Milan, Italy
Written by Jeffrey J. Tomaszewski, MD, medical writer for UroToday.com