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

Purpose: There is no consensus regarding a protective effect on mortality due to a cause other than cancer in patients treated with elective nephron sparing surgery relative to their radical nephrectomy counterparts. We test whether the protective effect of nephron sparing surgery relative to radical nephrectomy is universal or present in specific subgroups of patients. Materials and Methods: A collaborative database of 5 institutions was queried to evaluate 1,783 patients without chronic kidney disease diagnosed with a clinical T1 renal mass that was treated with nephron sparing surgery or radical nephrectomy. Multivariable Cox regression analysis was done to assess the impact of surgery type (nephron sparing surgery vs radical nephrectomy) on other cause mortality 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 subcohorts of patients. Results: Ten-year other cause mortality-free survival rates were 90% and 88% after nephron sparing surgery and radical nephrectomy, respectively. In the overall population radical nephrectomy was not associated with an increased risk of other cause mortality on multivariable analysis compared to nephron sparing surgery (HR 0.91, 95% CI 0.6e1.38, p ¼ 0.6). However, radical nephrectomy increased the risk of other cause mortality according to the increasing baseline Charlson comorbidity index (interaction test p ¼ 0.0008). For example, in a patient with a Charlson comorbidity index of 4 the probability of 10-year other cause mortality-free survival was 86% after nephron sparing surgery and 60% after radical nephrectomy. Conclusions: Elective nephron sparing surgery does not improve other cause survival relative to radical nephrectomy consistently in all patients with kidney cancer. Patients who are more ill with relevant comorbidities are those who benefit the most from nephron sparing surgery in terms of other cause mortality. Edition: ENGLISH DEUTSCH ESPAÑOL FRANÇAIS PORTUGUÊS Register Log In Medscape Logo Tuesday, October 4, 2016 News & Perspective Drugs & Diseases CME & Education MEDLINE Abstract Print ThisPrinter-Friendly Email This Email This Download ThisDownload This View OnlineView This Abstract Online Elective Nephron Sparing Surgery Decreases Other Cause Mortality Relative to Radical Nephrectomy Only in Specific Subgroups of Patients with Renal Cell Carcinoma. J Urol. 2016; 196(4):1008-13 (ISSN: 1527-3792) Larcher A; Capitanio U; Terrone C; Volpe A; De Angelis P; Dehó F; Fossati N; Dell'Oglio P; Antonelli A; Furlan M; Simeone C; Serni S; Carini M; Minervini A; Fiori C; Porpiglia F; Briganti A; Montorsi F; Bertini R PURPOSE: There is no consensus regarding a protective effect on mortality due to a cause other than cancer in patients treated with elective nephron sparing surgery relative to their radical nephrectomy counterparts. We test whether the protective effect of nephron sparing surgery relative to radical nephrectomy is universal or present in specific subgroups of patients. MATERIALS AND METHODS: A collaborative database of 5 institutions was queried to evaluate 1,783 patients without chronic kidney disease diagnosed with a clinical T1 renal mass that was treated with nephron sparing surgery or radical nephrectomy. Multivariable Cox regression analysis was done to assess the impact of surgery type (nephron sparing surgery vs radical nephrectomy) on other cause mortality 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 subcohorts of patients. RESULTS: Ten-year other cause mortality-free survival rates were 90% and 88% after nephron sparing surgery and radical nephrectomy, respectively. In the overall population radical nephrectomy was not associated with an increased risk of other cause mortality on multivariable analysis compared to nephron sparing surgery (HR 0.91, 95% CI 0.6-1.38, p = 0.6). However, radical nephrectomy increased the risk of other cause mortality according to the increasing baseline Charlson comorbidity index (interaction test p = 0.0008). For example, in a patient with a Charlson comorbidity index of 4 the probability of 10-year other cause mortality-free survival was 86% after nephron sparing surgery and 60% after radical nephrectomy. CONCLUSIONS: Elective nephron sparing surgery does not improve other cause survival relative to radical nephrectomy consistently in all patients with kidney cancer. Patients who are more ill with relevant comorbidities are those who benefit the most from nephron sparing surgery in terms of other cause mortality. Major Subject Heading(s) Minor Subject Heading(s) PreMedline Identifier: 27235789 From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine. Print ThisPrinter-Friendly Email This Email This Download ThisDownload This About About Medscape Privacy Policy Terms of Use Advertising Policy Help Center Membership Become a Member Email Newsletters Manage My Account Apps Medscape MedPulse News CME & Education WebMD Network WebMD MedicineNet eMedicineHealth RxList WebMD Corporate Editions English Deutsch Español Français Português All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties. This site is intended for healthcare professionals Edition: ENGLISH DEUTSCH ESPAÑOL FRANÇAIS PORTUGUÊS Register Log In Medscape Logo Tuesday, October 4, 2016 News & Perspective Drugs & Diseases CME & Education MEDLINE Abstract Print ThisPrinter-Friendly Email This Email This Download ThisDownload This View OnlineView This Abstract Online Elective Nephron Sparing Surgery Decreases Other Cause Mortality Relative to Radical Nephrectomy Only in Specific Subgroups of Patients with Renal Cell Carcinoma. J Urol. 2016; 196(4):1008-13 (ISSN: 1527-3792) Larcher A; Capitanio U; Terrone C; Volpe A; De Angelis P; Dehó F; Fossati N; Dell'Oglio P; Antonelli A; Furlan M; Simeone C; Serni S; Carini M; Minervini A; Fiori C; Porpiglia F; Briganti A; Montorsi F; Bertini R PURPOSE: There is no consensus regarding a protective effect on mortality due to a cause other than cancer in patients treated with elective nephron sparing surgery relative to their radical nephrectomy counterparts. We test whether the protective effect of nephron sparing surgery relative to radical nephrectomy is universal or present in specific subgroups of patients. MATERIALS AND METHODS: A collaborative database of 5 institutions was queried to evaluate 1,783 patients without chronic kidney disease diagnosed with a clinical T1 renal mass that was treated with nephron sparing surgery or radical nephrectomy. Multivariable Cox regression analysis was done to assess the impact of surgery type (nephron sparing surgery vs radical nephrectomy) on other cause mortality 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 subcohorts of patients. RESULTS: Ten-year other cause mortality-free survival rates were 90% and 88% after nephron sparing surgery and radical nephrectomy, respectively. In the overall population radical nephrectomy was not associated with an increased risk of other cause mortality on multivariable analysis compared to nephron sparing surgery (HR 0.91, 95% CI 0.6-1.38, p = 0.6). However, radical nephrectomy increased the risk of other cause mortality according to the increasing baseline Charlson comorbidity index (interaction test p = 0.0008). For example, in a patient with a Charlson comorbidity index of 4 the probability of 10-year other cause mortality-free survival was 86% after nephron sparing surgery and 60% after radical nephrectomy. CONCLUSIONS: Elective nephron sparing surgery does not improve other cause survival relative to radical nephrectomy consistently in all patients with kidney cancer. Patients who are more ill with relevant comorbidities are those who benefit the most from nephron sparing surgery in terms of other cause mortality. Major Subject Heading(s) Minor Subject Heading(s) PreMedline Identifier: 27235789 From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine. Print ThisPrinter-Friendly Email This Email This Download ThisDownload This About About Medscape Privacy Policy Terms of Use Advertising Policy Help Center Membership Become a Member Email Newsletters Manage My Account Apps Medscape MedPulse News CME & Education WebMD Network WebMD MedicineNet eMedicineHealth RxList WebMD Corporate Editions English Deutsch Español Français Português All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties. This site is intended for healthcare professionals Edition: ENGLISH DEUTSCH ESPAÑOL FRANÇAIS PORTUGUÊS Register Log In Medscape Logo Tuesday, October 4, 2016 News & Perspective Drugs & Diseases CME & Education MEDLINE Abstract Print ThisPrinter-Friendly Email This Email This Download ThisDownload This View OnlineView This Abstract Online Elective Nephron Sparing Surgery Decreases Other Cause Mortality Relative to Radical Nephrectomy Only in Specific Subgroups of Patients with Renal Cell Carcinoma. J Urol. 2016; 196(4):1008-13 (ISSN: 1527-3792) Larcher A; Capitanio U; Terrone C; Volpe A; De Angelis P; Dehó F; Fossati N; Dell'Oglio P; Antonelli A; Furlan M; Simeone C; Serni S; Carini M; Minervini A; Fiori C; Porpiglia F; Briganti A; Montorsi F; Bertini R PURPOSE: There is no consensus regarding a protective effect on mortality due to a cause other than cancer in patients treated with elective nephron sparing surgery relative to their radical nephrectomy counterparts. We test whether the protective effect of nephron sparing surgery relative to radical nephrectomy is universal or present in specific subgroups of patients. MATERIALS AND METHODS: A collaborative database of 5 institutions was queried to evaluate 1,783 patients without chronic kidney disease diagnosed with a clinical T1 renal mass that was treated with nephron sparing surgery or radical nephrectomy. Multivariable Cox regression analysis was done to assess the impact of surgery type (nephron sparing surgery vs radical nephrectomy) on other cause mortality 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 subcohorts of patients. RESULTS: Ten-year other cause mortality-free survival rates were 90% and 88% after nephron sparing surgery and radical nephrectomy, respectively. In the overall population radical nephrectomy was not associated with an increased risk of other cause mortality on multivariable analysis compared to nephron sparing surgery (HR 0.91, 95% CI 0.6-1.38, p = 0.6). However, radical nephrectomy increased the risk of other cause mortality according to the increasing baseline Charlson comorbidity index (interaction test p = 0.0008). For example, in a patient with a Charlson comorbidity index of 4 the probability of 10-year other cause mortality-free survival was 86% after nephron sparing surgery and 60% after radical nephrectomy. CONCLUSIONS: Elective nephron sparing surgery does not improve other cause survival relative to radical nephrectomy consistently in all patients with kidney cancer. Patients who are more ill with relevant comorbidities are those who benefit the most from nephron sparing surgery in terms of other cause mortality. Major Subject Heading(s) Minor Subject Heading(s) PreMedline Identifier: 27235789 From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine. Print ThisPrinter-Friendly Email This Email This Download ThisDownload This About About Medscape Privacy Policy Terms of Use Advertising Policy Help Center Membership Become a Member Email Newsletters Manage My Account Apps Medscape MedPulse News CME & Education WebMD Network WebMD MedicineNet eMedicineHealth RxList WebMD Corporate Editions English Deutsch Español Français Português All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties. PURPOSE: There is no consensus regarding a protective effect on mortality due to a cause other than cancer in patients treated with elective nephron sparing surgery relative to their radical nephrectomy counterparts. We test whether the protective effect of nephron sparing surgery relative to radical nephrectomy is universal or present in specific subgroups of patients. MATERIALS AND METHODS: A collaborative database of 5 institutions was queried to evaluate 1,783 patients without chronic kidney disease diagnosed with a clinical T1 renal mass that was treated with nephron sparing surgery or radical nephrectomy. Multivariable Cox regression analysis was done to assess the impact of surgery type (nephron sparing surgery vs radical nephrectomy) on other cause mortality 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 subcohorts of patients. RESULTS: Ten-year other cause mortality-free survival rates were 90% and 88% after nephron sparing surgery and radical nephrectomy, respectively. In the overall population radical nephrectomy was not associated with an increased risk of other cause mortality on multivariable analysis compared to nephron sparing surgery (HR 0.91, 95% CI 0.6-1.38, p = 0.6). However, radical nephrectomy increased the risk of other cause mortality according to the increasing baseline Charlson comorbidity index (interaction test p = 0.0008). For example, in a patient with a Charlson comorbidity index of 4 the probability of 10-year other cause mortality-free survival was 86% after nephron sparing surgery and 60% after radical nephrectomy. CONCLUSIONS: Elective nephron sparing surgery does not improve other cause survival relative to radical nephrectomy consistently in all patients with kidney cancer. Patients who are more ill with relevant comorbidities are those who benefit the most from nephron sparing surgery in terms of other cause mortality