Conditional survival of patients with nonmetastatic renal cell carcinoma: How cancer-specific mortality changes after nephrectomy: JNCCN Journal of the National Comprehensive Cancer Network

C. Palumbo, F.A. Mistretta, S. Knipper, A. Pecoraro, Z. Tian, S.F. Shariat, F. Saad, C. Simeone, A. Briganti, A. Antonelli, P.I. Karakiewicz

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Conditional survival (CS) may reveal important differences in cancer-specific mortality (CSM) among patients with nonmetastatic renal cell carcinoma (nmRCC). This study assessed CS according to T and N stages in patients treated surgically for nmRCC. Patients and Methods: Within the SEER database (2001–2015), all patients with nmRCC treated with either partial or radical nephrectomy were identified. CSM-free estimates according to T and N stage and substage groupings (pT1aN0–pT4N0 and pTanyN1) and multivariable Cox regression models with adjustment for Fuhrman grade and histologic subtype were assessed. Results: According to T and N stage and substage groupings, the following patients were included in the study: 35,966 (46.2%) with pT1aN0 disease; 18,858 (24.2%) with pT1bN0; 5,977 (7.7%) with pT2aN0; 2,511 (3.2%) with pT2bN0; 11,839 (15.2%) with pT3aN0; 1,037 (1.3%) with pT3b–cN0; 402 (0.5%) with pT4N0; and 1,302 (1.7%) with pTanyN1. Conditional CSM-free survival estimates were 98.2% at 1 year versus 98.0% at 10 years of event-free follow-up for patients with pT1aN0 disease, relative to baseline. Conversely, pT4N0/pTanyN1 conditional CSM-free survival estimates were 55.8% at 1 year versus 77.9% at 8 years of event-free follow-up. Attrition due to mortality was highest in patients with pT4N0/pTanyN1 disease. In multivariable Cox regression analyses, T stage, tumor grade, and histologic subtype represented independent predictors, but no interactions were identified. Conclusions: Tumor stage and its substages represent extremely important determinants of prognosis after lengthy event-free follow-up. The recorded observations have critical importance for physicians regarding patient follow-up and counseling. © 2020 Harborside Press. All rights reserved
Original languageEnglish
Pages (from-to)44-51
Number of pages8
JournalJNCCN J. Nat. Compr. Cancer Netw.
Volume18
Issue number1
DOIs
Publication statusPublished - 2020

Keywords

  • adult
  • aged
  • Article
  • cancer mortality
  • cancer patient
  • cancer staging
  • cancer surgery
  • cancer survival
  • female
  • follow up
  • human
  • major clinical study
  • male
  • partial nephrectomy
  • radical nephrectomy
  • renal cell carcinoma
  • survival rate

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