Elective Nephron Sparing Surgery Decreases Other-Causes Mortality Relative to Radical Nephrectomy Only in Specific Subgroups of Patients with Renal Cell Carcinoma: Impact of Nephron Sparing Surgery on Non-Cancer Mortality

There is no consensus regarding a protective effect on mortality due to cause other than cancer (OCM) for patients treated with elective nephron-sparing surgery (NSS) relative to their radical nephrectomy (RN) counterparts. The aim of the study was to test whether the protective effect of NSS relative to RN is universal or present in specific sub-groups of patients.

A collaborative database of five Institutions was queried to evaluate 1,783 patients without chronic kidney disease diagnosed with a clinical T1 renal mass treated with NSS or RN. Multivariable Cox regression analysis (MVA) assessed the impact of surgery type (NSS v. RN) on other cause mortality (OCM) after adjustment for patient and cancer characteristics. Interaction terms were used to test the hypothesis that the impact of surgery type varies according to specific sub-cohorts of patients.

The 10-years OCM-free survival rates were 90 and 88% after NSS and RN, respectively. In the overall population, RN was not associated with an increased risk of OCM at MVA (Hazard ratio: 0.91; 95% Confidence interval: 0.6-1.38; p=0.6) compared to NSS. However, RN increased the risk of OCM according to increasing baseline CCI (Interaction test p=0.0008). For example, for a patient with CCI=4, the probability of 10-years OCM free survival was 86% after NSS and 60% after RN.

Elective NSS does not improve other-causes survival relative to RN consistently in all kidney cancer patients. Sicker patients with relevant comorbidities are those who benefit the most from NSS in terms of OCM.

The Journal of urology. 2016 May 25 [Epub ahead of print]

Alessandro Larcher, Umberto Capitanio, Carlo Terrone, Alessandro Volpe, Paolo De Angelis, Federico Deho, Nicola Fossati, Paolo Dell'Oglio, Alessandro Antonelli, Maria Furlan, Claudio Simeone, Sergio Serni, Marco Carini, Andrea Minervini, Cristian Fiori, Francesco Porpiglia, Alberto Briganti, Francesco Montorsi, Roberto Bertini

URI - Urological Research Institute, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Unit of Urology, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy., URI - Urological Research Institute, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Unit of Urology, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy. Electronic address: ., Dept. of Urology, University of Piemonte Orientale, Novara., Dept. of Urology, University of Piemonte Orientale, Novara., Dept. of Urology, University of Piemonte Orientale, Novara., URI - Urological Research Institute, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Unit of Urology, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy., URI - Urological Research Institute, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Unit of Urology, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy., URI - Urological Research Institute, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Unit of Urology, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy., Dept. of Urology, Universita' degli studi e Spedali Civili di Brescia., Dept. of Urology, Universita' degli studi e Spedali Civili di Brescia., Dept. of Urology, Universita' degli studi e Spedali Civili di Brescia., Dept. of Urology, Clinica Urologica I, Azienda Ospedaliera Universitaria Careggi, Università degli studi di Firenze., Dept. of Urology, Clinica Urologica I, Azienda Ospedaliera Universitaria Careggi, Università degli studi di Firenze., Dept. of Urology, Clinica Urologica I, Azienda Ospedaliera Universitaria Careggi, Università degli studi di Firenze., Dept. of Urology, AOU San Luigi Gonzaga, Università degli studi di Torino, Orbassano., Dept. of Urology, AOU San Luigi Gonzaga, Università degli studi di Torino, Orbassano., URI - Urological Research Institute, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Unit of Urology, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy., URI - Urological Research Institute, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Unit of Urology, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy., URI - Urological Research Institute, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Unit of Urology, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy.

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