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Should patients wit...
Should patients with low-risk renal cell carcinoma be followed differently after nephron-sparing surgery vs radical nephrectomy?
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- Abu-Ghanem, Yasmin (författare)
- UCL Division of Surgical and Interventional Science, Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, United Kingdom
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- Powles, Thomas (författare)
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
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- Capitanio, Umberto (författare)
- Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy,San Raffaele Scientific Institute
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- Beisland, Christian (författare)
- Department of Urology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
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- Järvinen, Petrus (författare)
- Urology, Abdominal Centre, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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- Stewart, Grant D. (författare)
- Department of Surgery, University of Cambridge, Cambridge, United Kingdom
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- Gudmundsson, Eirikur (författare)
- Department of Urology, Landspitali University Hospital, Reykjavik, Iceland,National University Hospital of Iceland
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- Lam, Thomas B.L. (författare)
- Umeå University
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- Marconi, Lorenzo (författare)
- Department of Urology, Coimbra University Hospital, Coimbra, Portugal
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- Fernandéz-Pello, Sergio (författare)
- Department of Urology, Cabueñes University Hospital, Gijón, Spain
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- Nisen, Harry (författare)
- Urology, Abdominal Centre, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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- Meijer, Richard P. (författare)
- Department of Oncological Urology, University Medical Centre Utrecht, Utrecht, Netherlands
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- Volpe, Alessandro (författare)
- Department of Urology, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
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- Ljungberg, Börje, Professor, 1949- (författare)
- Umeå universitet,Urologi och andrologi
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- Klatte, Tobias (författare)
- Department of Surgery, University of Cambridge, Cambridge, United Kingdom; Department of Urology, Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, United Kingdom
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- Bensalah, Karim (författare)
- Department of Urology, University Hospital of Rennes, Rennes, France
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- Dabestani, Saeed (författare)
- Lund University,Lunds universitet,Urologisk cancerforskning, Malmö,Forskargrupper vid Lunds universitet,Urological cancer, Malmö,Lund University Research Groups,Central Hospital Kristianstad
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- Bex, Axel (författare)
- UCL Division of Surgical and Interventional Science, Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, United Kingdom; Department of Urology, Netherlands Cancer Institute, Amsterdam, Netherlands
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(creator_code:org_t)
- 2021-04-26
- 2021
- Engelska.
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Ingår i: BJU International. - : John Wiley & Sons. - 1464-4096 .- 1464-410X. ; 128:3, s. 386-394
- Relaterad länk:
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http://dx.doi.org/10...
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https://urn.kb.se/re...
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https://doi.org/10.1...
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https://lup.lub.lu.s...
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Abstract
Ämnesord
Stäng
- Objective: To investigate whether pT1 renal cell carcinoma (RCC) should be followed differently after partial (PN) or radical nephrectomy (RN) based on a retrospective analysis of a multicentre database (RECUR).Subjects: A retrospective study was conducted in 3380 patients treated for nonmetastatic RCC between January 2006 and December 2011 across 15 centres from 10 countries, as part of the RECUR database project. For patients with pT1 clear-cell RCC, patterns of recurrence were compared between RN and PN according to recurrence site. Univariate and multivariate models were used to evaluate the association between surgical approach and recurrence-free survival (RFS) and cancer-specific mortality (CSM).Results: From the database 1995 patients were identified as low-risk patients (pT1, pN0, pNx), of whom 1055 (52.9%) underwent PN. On multivariate analysis, features associated with worse RFS included tumour size (hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.14–1.39; P < 0.001), nuclear grade (HR 2.31, 95% CI 1.73–3.08; P < 0.001), tumour necrosis (HR 1.5, 95% CI 1.03–2.3; P = 0.037), vascular invasion (HR 2.4, 95% CI 1.3–4.4; P = 0.005) and positive surgical margins (HR 4.4, 95% CI 2.3–8.5; P < 0.001). Kaplan–Meier analysis of CSM revealed that the survival of patients with recurrence after PN was significantly better than those with recurrence after RN (P = 0.02). While the above-mentioned risk factors were associated with prognosis, type of surgery alone was not an independent prognostic variable for RFS nor CSM. Limitations include the retrospective nature of the study.Conclusion: Our results showed that follow-up protocols should not rely solely on stage and type of primary surgery. An optimized regimen should also include validated risk factors rather than type of surgery alone to select the best imaging method and to avoid unnecessary imaging. A follow-up of more than 3 years should be considered in patients with pT1 tumours after RN. A novel follow-up strategy is proposed.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Urologi och njurmedicin (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Urology and Nephrology (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Cancer och onkologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cancer and Oncology (hsv//eng)
Nyckelord
- #kcsm
- #Kidney Cancer
- #uroonc
- follow up
- guidelines
- partial nephrectomy
- radical nephrectomy
- RECUR
- renal cell carcinoma
- survival
- #kcsm
- #Kidney Cancer
- #uroonc
- follow up
- guidelines
- partial nephrectomy
- radical nephrectomy
- RECUR
- renal cell carcinoma
- survival
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Abu-Ghanem, Yasm ...
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Powles, Thomas
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Capitanio, Umber ...
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Beisland, Christ ...
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Järvinen, Petrus
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Stewart, Grant D ...
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Gudmundsson, Eir ...
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Lam, Thomas B.L.
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Marconi, Lorenzo
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Fernandéz-Pello, ...
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Nisen, Harry
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Meijer, Richard ...
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Volpe, Alessandr ...
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Ljungberg, Börje ...
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Klatte, Tobias
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Bensalah, Karim
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Dabestani, Saeed
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Bex, Axel
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