TY - JOUR
T1 - Nephron-sparing surgery is superior to radical nephrectomy in preserving renal function benefit even when expanding indications beyond the traditional 4-cm cutoff
AU - Pignot, Géraldine
AU - Bigot, Pierre
AU - Bernhard, Jean Christophe
AU - Bouliere, Fabien
AU - Bessede, Thomas
AU - Bensalah, Karim
AU - Salomon, Laurent
AU - Mottet, Nicolas
AU - Bellec, Laurent
AU - Soulié, Michel
AU - Ferrière, Jean Marie
AU - Pfister, Christian
AU - Drai, Julien
AU - Colombel, Marc
AU - Villers, Arnauld
AU - Rigaud, Jerome
AU - Bouchot, Olivier
AU - Montorsi, Francesco
AU - Bertini, Roberto
AU - Belldegrun, Arie S.
AU - Pantuck, Allan J.
AU - Patard, Jean Jacques
PY - 2014/10/1
Y1 - 2014/10/1
N2 - Objectives: To analyze to what extent partial nephrectomy (PN) is superior to radical nephrectomy (RN) in preserving renal function outcome in relation to tumor size indication. Methods and materials: Clinical data from 973 patients operated at 9 academic institutions were retrospectively analyzed. Glomerular filtration rate (GFR) before and after surgery was calculated with the abbreviated Modification of the Diet in Renal Disease equation. For a fair comparison between the 2 techniques, all imperative indications for PN were excluded. A shift to a less favorable GFR group following surgery was considered clinically significant. Results: Median age at diagnosis was 60 years (19-91). Tumor size was smaller than 4. cm in 665 (68.3%) cases and larger than 4. cm in 308 (31.7%) cases. PN and RN were performed in 663 (68.1%) and 310 (31.9%) patients, respectively. In univariate analysis, patients undergoing PN had a smaller risk for developing significant GFR change following surgery than those undergoing RN did. This was true for tumors≤4. cm (P = 0.0001) and for tumors>4. cm (P = 0.0001). In multivariate analysis, the following criteria were independent predictive factors for developing significant postoperative GFR loss: the use of RN (P = 0.0001), preoperative GFR
AB - Objectives: To analyze to what extent partial nephrectomy (PN) is superior to radical nephrectomy (RN) in preserving renal function outcome in relation to tumor size indication. Methods and materials: Clinical data from 973 patients operated at 9 academic institutions were retrospectively analyzed. Glomerular filtration rate (GFR) before and after surgery was calculated with the abbreviated Modification of the Diet in Renal Disease equation. For a fair comparison between the 2 techniques, all imperative indications for PN were excluded. A shift to a less favorable GFR group following surgery was considered clinically significant. Results: Median age at diagnosis was 60 years (19-91). Tumor size was smaller than 4. cm in 665 (68.3%) cases and larger than 4. cm in 308 (31.7%) cases. PN and RN were performed in 663 (68.1%) and 310 (31.9%) patients, respectively. In univariate analysis, patients undergoing PN had a smaller risk for developing significant GFR change following surgery than those undergoing RN did. This was true for tumors≤4. cm (P = 0.0001) and for tumors>4. cm (P = 0.0001). In multivariate analysis, the following criteria were independent predictive factors for developing significant postoperative GFR loss: the use of RN (P = 0.0001), preoperative GFR
KW - Chronic renal disease
KW - Glomerular filtration rate
KW - Partial nephrectomy
KW - Renal cell carcinoma
KW - Renal function
KW - Survival
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U2 - 10.1016/j.urolonc.2014.03.012
DO - 10.1016/j.urolonc.2014.03.012
M3 - Article
C2 - 24996775
AN - SCOPUS:84922105812
VL - 32
SP - 1024
EP - 1030
JO - Urologic Oncology
JF - Urologic Oncology
SN - 1078-1439
IS - 7
ER -