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Partial versus Radical Nephrectomy for T1-T2 Renal Cell Carcinoma in Patients with Chronic Kidney Disease Stage III: a Multiinstitutional Analysis of Kidney Function and Survival Rate

 Jae-Seung Chung  ;  Nak Hoon Son  ;  Sang Eun Lee  ;  Sung Kyu Hong  ;  Chang Wook Jeong  ;  Cheol Kwak  ;  Hyeon Hoe Kim  ;  Sung Hoo Hong  ;  Yong June Kim  ;  Seok Ho Kang  ;  Jinsoo Chung  ;  Tae Gyun Kwon  ;  Eu Chang Hwang  ;  Seok-Soo Byun 
 Journal of Korean Medical Science, Vol.33(43) : e277, 2018 
Journal Title
 Journal of Korean Medical Science 
Issue Date
Aged ; Carcinoma, Renal Cell/complications ; Carcinoma, Renal Cell/diagnosis* ; Carcinoma, Renal Cell/mortality ; Carcinoma, Renal Cell/surgery ; Female ; Humans ; Kidney Neoplasms/complications ; Kidney Neoplasms/diagnosis* ; Kidney Neoplasms/mortality ; Kidney Neoplasms/surgery ; Male ; Middle Aged ; Nephrectomy/methods* ; Proportional Hazards Models ; Renal Insufficiency, Chronic/complications ; Renal Insufficiency, Chronic/diagnosis* ; Renal Insufficiency, Chronic/pathology ; Republic of Korea ; Retrospective Studies ; Severity of Illness Index ; Survival Rate
Carcinoma, Renal Cell ; Nephrectomy ; Renal Insufficiency ; Survival
BACKGROUND: To examine survival rates and renal function after partial nephrectomy (PN) and radical nephrectomy (RN) in patients with chronic kidney disease (CKD). METHODS: We studied 4,332 patients who underwent PN or RN for pathological T1a-T2N0M0 renal cell carcinoma from 1988 to 2014. Patients were divided into two subgroups of CKD stage I-II and stage III. Kidney function, and survival outcomes were compared between groups. RESULTS: We included 1,756 patients with CKD I-II and 276 patients with CKD III in the final pair-matched analysis. Kidney function was significantly better preserved in the PN than in the RN group among all patients. However, the beneficial effect of PN on kidney function gradually disappeared over time in CKD III patients. The 5-year overall survival (OS) rates after PN and RN differed in patients with CKD I-II disease (99.4% vs. 96.5%, respectively, P = 0.015). The 5-year OS rates after surgery were not affected by mode of nephrectomy in CKD III patients (97.8% vs. 93.5%, P = 0.103). The 5-year cancer-specific survival rates did not differ between treatment groups in all CKD stage. Cox hazard analysis showed that the operative method was a significant factor for OS in CKD I-II patients (hazard ratio [HR], 0.320; confidence interval [CI], 0.122-0.840; P = 0.021). However, PN was not beneficial in terms of OS in CKD III patients (HR, 0.395; CI, 0.086-1.172; P = 0.117). CONCLUSION: PN is associated with a higher OS rate and better kidney function in patients with preoperative CKD stage I and II, but not in those with CKD stage III.
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1. College of Medicine (의과대학) > Dept. of Biomedical Systems Informatics (의생명시스템정보학교실) > 1. Journal Papers
Yonsei Authors
Son, Nak Hoon(손낙훈) ORCID logo https://orcid.org/0000-0002-6192-8852
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