Recurrence after radical and partial nephrectomy in high complex renal tumor using propensity score matched analysis
Open Access
- 3 February 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in Scientific Reports
- Vol. 11 (1), 1-8
- https://doi.org/10.1038/s41598-021-82700-8
Abstract
We evaluated the recurrence after radical and partial nephrectomy in patients with RENAL nephrometry score [RENAL] ≥ 10. A total of 474 patients (radical nephrectomy [RN, n = 236] & partial nephrectomy [PN, n = 238]) in a single tertiary referral institution from December 2003 to December 2019 were assessed. Functional outcomes, defined as estimated glomerular filtration rate changes, relapse pattern, recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were evaluated using propensity score-matched analysis. The predictors of recurrence and survival were assessed by Cox-regression analysis. 44 patients in the RN group and 88 in the PN group were included without significant differences in preoperative clinical factors after matching. The PN patients achieved significantly higher renal function preservation rates (p < 0.001). There were five recurrences in RN and six in PN. The PN patients revealed 5-year RFS rate (86.8%), 5-year CSS rate (98.5%), and 5-year OS rate (98.5%) comparable to the RN patients (RFS: 88.7% [p = 0.780], CSS: 96.7% [p = 0.375], and OS: 94.3% [p = 0.248]). Patients with a body mass index (BMI) ≥ 23 had lower 5-year RFS rates (85.5%) and OS rates (95.6%) than those with BMI < 23 (RFS: 90.0% [p = 0.195], OS: 100% [p = 0.117]) without significance. The significant predictor of recurrence was the pathologic T stage (hazard ratio [HR] 3.99, 95% confidence [CI] 1.10–14.50, p = 0.036). The significant predictor of death was the R domain of the RENAL (HR 3.80, 95% CI 1.03–14.11, p = 0.046). PN, if technically feasible, could be considered to preserve renal function in patients with RENAL ≥ 10. Nonetheless, PN needs to be implemented with caution in some patients due to the higher potentiality for recurrence and poor survival.This publication has 24 references indexed in Scilit:
- Management of Renal Masses and Localized Renal Cancer: Systematic Review and Meta-AnalysisJournal of Urology, 2016
- Surgical Management of Local Retroperitoneal Recurrence of Renal Cell Carcinoma after Radical NephrectomyJournal of Urology, 2015
- Comparison of Partial Nephrectomy and Percutaneous Ablation for cT1 Renal MassesEuropean Urology, 2015
- Renal Cell Recurrence for T1 Tumors After Laparoscopic Partial NephrectomyJournal of Endourology, 2013
- An Epidemiologic and Genomic Investigation Into the Obesity Paradox in Renal Cell CarcinomaJNCI Journal of the National Cancer Institute, 2013
- 10-Year Oncologic Outcomes After Laparoscopic and Open Partial NephrectomyJournal of Urology, 2013
- Body mass index and survival in patients with renal cell carcinoma: A clinical‐based cohort and meta‐analysisInternational Journal of Cancer, 2012
- The R.E.N.A.L. Nephrometry Score: A Comprehensive Standardized System for Quantitating Renal Tumor Size, Location and DepthJournal of Urology, 2009
- Predictors of Oncological Outcome After Resection of Locally Recurrent Renal Cell CarcinomaJournal of Urology, 2009
- OUTCOME OF ISOLATED RENAL CELL CARCINOMA FOSSA RECURRENCE AFTER NEPHRECTOMYJournal of Urology, 2000