Partial nephrectomy (PN) is technically feasible in patients with metastatic renal cell carcinoma (mRCC). We tested the contemporary effect of PN on cancer-specific mortality (CSM), other-cause mortality (OCM) and early postoperative outcomes compared to radical nephrectomy (RN) in mRCC patients.
In the first part, we identified surgically treated mRCC patients within the SEER database (2004-2013). After propensity-score (PS) matching, cumulative incidence plots and multivariable competing-risks regression (CRR) models were used. In the second part, we identified surgically treated mRCC patients within the NIS database (2004-2013). After PS matching, multivariable logistic regression (MLR) and multivariable Poisson regression (MPR) models were used.
Within the SEER database, 217 (4.2%) of 5171 mRCC patients underwent PN. After 4:1 PS matching, multivariable CRR models showed lower OCM rates in PN patients (hazard ratio [HR]: 0.23, p = 0.01). No difference in CSM was reported in PN vs. RN patients (p = 0.08). Within the NIS database, 226 (4.4%) of 5138 patients underwent PN. After 4:1 PS matching, MLR showed lower rates of transfusions (odds ratio [OR]: 0.46, P < 0.001), intraoperative (OR: 0.33, p = 0.02) and miscellaneous surgical complications (OR: 0.42, p = 0.009) in PN vs. RN patients. No difference in overall complications (OR: 1.00, p = 0.9) and in-hospital mortality (OR: 1.2, p = 0.8) was observed. In MPR, PN did not affect LOS (OR: 0.94, p = 0.3).
We demonstrate that PN is associated with lower OCM in the setting of mRCC, but not with differences in other examined endpoints. In consequence, PN merits greater consideration in the context of mRCC.
Cancer epidemiology. 2018 Aug 30 [Epub ahead of print]
Elio Mazzone, Sebastiano Nazzani, Felix Preisser, Zhe Tian, Michele Marchioni, Marco Bandini, Umberto Capitanio, Anil Kapoor, Derya Tilki, Francesco Montorsi, Shahrokh F Shariat, Fred Saad, Alberto Briganti, Pierre I Karakiewicz
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy. Electronic address: ., Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Academic Department of Urology, IRCCS Policlinico San Donato, University of Milan, Milan, Italy., Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Martini Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada., Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Department of Urology, SS Annunziata Hospital, "G. D'Annunzio" University of Chieti, Chieti, Italy., Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy., Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy., Division of Urology, McMaster University, Hamilton, Ontario, Canada., Martini Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany., Department of Urology, Medical University of Vienna, Vienna, Austria.