Nephron-sparing techniques independently decrease the risk of cardiovascular events relative to radical nephrectomy in patients with a T1a-T1b renal mass and normal preoperative renal function

Umberto Capitanio, Carlo Terrone, Alessandro Antonelli, Andrea Minervini, Alessandro Volpe, Maria Furlan, Rayan Matloob, Federica Regis, Cristian Fiori, Francesco Porpiglia, Ettore Di Trapani, Monica Zacchero, Sergio Serni, Andrea Salonia, Marco Carini, Claudio Simeone, Francesco Montorsi, Roberto Bertini

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Abstract

Background Some reports have suggested that nephron-sparing surgery (NSS) may protect against cardiovascular events (CVe) when compared with radical nephrectomy (RN). However, previous studies did not adjust the results for potential selection bias secondary to baseline cardiovascular risk. Objective To test the effect of treatment type (NSS vs RN) on the risk of developing CVe after accounting for individual cardiovascular risk. Design, setting, and participants A multi-institutional collaboration including 1331 patients with a clinical T1a-T1b N0 M0 renal mass and normal renal function before surgery (defined as an estimated glomerular filtration rate ≥60 ml/min/1.73 m2). Intervention RN (n = 462, 34.7%) or NSS (n = 869, 65.3%) between 1987 and 2013. Outcome measurement and statistical analyses CVe was defined as onset during the follow-up period of coronary artery disease, cardiomyopathy, hypertension, vasculopathy, heart failure, dysrhythmias, or cerebrovascular disease not known before surgery. Cox regression analyses were performed. To adjust for inherent baseline differences among patients, we performed multivariate analyses adjusting for all available characteristics depicting the overall and cardiovascular-specific profile of the patients. Results and limitations When stratifying for treatment type, the proportion of patients who experienced CVe at 1, 5, and 10 yr was 5.5%, 9.9%, and 20.2% for NSS patients compared to 8.7%, 15.6%, and 25.9%, respectively, for RN patients (p = 0.001). In multivariate analyses, patients who underwent NSS showed a significantly lower risk of developing CVe compared with their RN counterparts (hazard ratio 0.57, 95% confidence interval 0.34-0.96; p = 0.03) after accounting for clinical characteristics and cardiovascular profile. Limitations include the retrospective design of the study because other potential confounders may exist. Conclusions The risk of CVe after renal surgery is not negligible. Patients treated with NSS have roughly half the risk of developing CVe relative to their RN counterparts. After accounting for clinical characteristics, comorbidities, and cardiovascular risk at diagnosis, NSS independently decreases the risk of CVe relative to RN. Patient summary The risk of having a cardiovascular event after renal surgery decreases if a portion of the affected kidney is spared.

Original languageEnglish
Pages (from-to)683-689
Number of pages7
JournalEuropean Urology
Volume67
Issue number4
DOIs
Publication statusPublished - Apr 1 2015

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Nephrons
Nephrectomy
Kidney
Multivariate Analysis
Cerebrovascular Disorders
Selection Bias
Glomerular Filtration Rate
Cardiomyopathies
Comorbidity
Coronary Artery Disease
Heart Failure
Retrospective Studies
Regression Analysis
Confidence Intervals
Hypertension

Keywords

  • Cardiovascular event
  • Kidney cancer
  • Nephron-sparing surgery
  • Overall survival
  • Partial nephrectomy
  • Radical nephrectomy

ASJC Scopus subject areas

  • Urology
  • Medicine(all)

Cite this

Nephron-sparing techniques independently decrease the risk of cardiovascular events relative to radical nephrectomy in patients with a T1a-T1b renal mass and normal preoperative renal function. / Capitanio, Umberto; Terrone, Carlo; Antonelli, Alessandro; Minervini, Andrea; Volpe, Alessandro; Furlan, Maria; Matloob, Rayan; Regis, Federica; Fiori, Cristian; Porpiglia, Francesco; Di Trapani, Ettore; Zacchero, Monica; Serni, Sergio; Salonia, Andrea; Carini, Marco; Simeone, Claudio; Montorsi, Francesco; Bertini, Roberto.

In: European Urology, Vol. 67, No. 4, 01.04.2015, p. 683-689.

Research output: Contribution to journalArticle

Capitanio, U, Terrone, C, Antonelli, A, Minervini, A, Volpe, A, Furlan, M, Matloob, R, Regis, F, Fiori, C, Porpiglia, F, Di Trapani, E, Zacchero, M, Serni, S, Salonia, A, Carini, M, Simeone, C, Montorsi, F & Bertini, R 2015, 'Nephron-sparing techniques independently decrease the risk of cardiovascular events relative to radical nephrectomy in patients with a T1a-T1b renal mass and normal preoperative renal function', European Urology, vol. 67, no. 4, pp. 683-689. https://doi.org/10.1016/j.eururo.2014.09.027
Capitanio, Umberto ; Terrone, Carlo ; Antonelli, Alessandro ; Minervini, Andrea ; Volpe, Alessandro ; Furlan, Maria ; Matloob, Rayan ; Regis, Federica ; Fiori, Cristian ; Porpiglia, Francesco ; Di Trapani, Ettore ; Zacchero, Monica ; Serni, Sergio ; Salonia, Andrea ; Carini, Marco ; Simeone, Claudio ; Montorsi, Francesco ; Bertini, Roberto. / Nephron-sparing techniques independently decrease the risk of cardiovascular events relative to radical nephrectomy in patients with a T1a-T1b renal mass and normal preoperative renal function. In: European Urology. 2015 ; Vol. 67, No. 4. pp. 683-689.
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abstract = "Background Some reports have suggested that nephron-sparing surgery (NSS) may protect against cardiovascular events (CVe) when compared with radical nephrectomy (RN). However, previous studies did not adjust the results for potential selection bias secondary to baseline cardiovascular risk. Objective To test the effect of treatment type (NSS vs RN) on the risk of developing CVe after accounting for individual cardiovascular risk. Design, setting, and participants A multi-institutional collaboration including 1331 patients with a clinical T1a-T1b N0 M0 renal mass and normal renal function before surgery (defined as an estimated glomerular filtration rate ≥60 ml/min/1.73 m2). Intervention RN (n = 462, 34.7{\%}) or NSS (n = 869, 65.3{\%}) between 1987 and 2013. Outcome measurement and statistical analyses CVe was defined as onset during the follow-up period of coronary artery disease, cardiomyopathy, hypertension, vasculopathy, heart failure, dysrhythmias, or cerebrovascular disease not known before surgery. Cox regression analyses were performed. To adjust for inherent baseline differences among patients, we performed multivariate analyses adjusting for all available characteristics depicting the overall and cardiovascular-specific profile of the patients. Results and limitations When stratifying for treatment type, the proportion of patients who experienced CVe at 1, 5, and 10 yr was 5.5{\%}, 9.9{\%}, and 20.2{\%} for NSS patients compared to 8.7{\%}, 15.6{\%}, and 25.9{\%}, respectively, for RN patients (p = 0.001). In multivariate analyses, patients who underwent NSS showed a significantly lower risk of developing CVe compared with their RN counterparts (hazard ratio 0.57, 95{\%} confidence interval 0.34-0.96; p = 0.03) after accounting for clinical characteristics and cardiovascular profile. Limitations include the retrospective design of the study because other potential confounders may exist. Conclusions The risk of CVe after renal surgery is not negligible. Patients treated with NSS have roughly half the risk of developing CVe relative to their RN counterparts. After accounting for clinical characteristics, comorbidities, and cardiovascular risk at diagnosis, NSS independently decreases the risk of CVe relative to RN. Patient summary The risk of having a cardiovascular event after renal surgery decreases if a portion of the affected kidney is spared.",
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T1 - Nephron-sparing techniques independently decrease the risk of cardiovascular events relative to radical nephrectomy in patients with a T1a-T1b renal mass and normal preoperative renal function

AU - Capitanio, Umberto

AU - Terrone, Carlo

AU - Antonelli, Alessandro

AU - Minervini, Andrea

AU - Volpe, Alessandro

AU - Furlan, Maria

AU - Matloob, Rayan

AU - Regis, Federica

AU - Fiori, Cristian

AU - Porpiglia, Francesco

AU - Di Trapani, Ettore

AU - Zacchero, Monica

AU - Serni, Sergio

AU - Salonia, Andrea

AU - Carini, Marco

AU - Simeone, Claudio

AU - Montorsi, Francesco

AU - Bertini, Roberto

PY - 2015/4/1

Y1 - 2015/4/1

N2 - Background Some reports have suggested that nephron-sparing surgery (NSS) may protect against cardiovascular events (CVe) when compared with radical nephrectomy (RN). However, previous studies did not adjust the results for potential selection bias secondary to baseline cardiovascular risk. Objective To test the effect of treatment type (NSS vs RN) on the risk of developing CVe after accounting for individual cardiovascular risk. Design, setting, and participants A multi-institutional collaboration including 1331 patients with a clinical T1a-T1b N0 M0 renal mass and normal renal function before surgery (defined as an estimated glomerular filtration rate ≥60 ml/min/1.73 m2). Intervention RN (n = 462, 34.7%) or NSS (n = 869, 65.3%) between 1987 and 2013. Outcome measurement and statistical analyses CVe was defined as onset during the follow-up period of coronary artery disease, cardiomyopathy, hypertension, vasculopathy, heart failure, dysrhythmias, or cerebrovascular disease not known before surgery. Cox regression analyses were performed. To adjust for inherent baseline differences among patients, we performed multivariate analyses adjusting for all available characteristics depicting the overall and cardiovascular-specific profile of the patients. Results and limitations When stratifying for treatment type, the proportion of patients who experienced CVe at 1, 5, and 10 yr was 5.5%, 9.9%, and 20.2% for NSS patients compared to 8.7%, 15.6%, and 25.9%, respectively, for RN patients (p = 0.001). In multivariate analyses, patients who underwent NSS showed a significantly lower risk of developing CVe compared with their RN counterparts (hazard ratio 0.57, 95% confidence interval 0.34-0.96; p = 0.03) after accounting for clinical characteristics and cardiovascular profile. Limitations include the retrospective design of the study because other potential confounders may exist. Conclusions The risk of CVe after renal surgery is not negligible. Patients treated with NSS have roughly half the risk of developing CVe relative to their RN counterparts. After accounting for clinical characteristics, comorbidities, and cardiovascular risk at diagnosis, NSS independently decreases the risk of CVe relative to RN. Patient summary The risk of having a cardiovascular event after renal surgery decreases if a portion of the affected kidney is spared.

AB - Background Some reports have suggested that nephron-sparing surgery (NSS) may protect against cardiovascular events (CVe) when compared with radical nephrectomy (RN). However, previous studies did not adjust the results for potential selection bias secondary to baseline cardiovascular risk. Objective To test the effect of treatment type (NSS vs RN) on the risk of developing CVe after accounting for individual cardiovascular risk. Design, setting, and participants A multi-institutional collaboration including 1331 patients with a clinical T1a-T1b N0 M0 renal mass and normal renal function before surgery (defined as an estimated glomerular filtration rate ≥60 ml/min/1.73 m2). Intervention RN (n = 462, 34.7%) or NSS (n = 869, 65.3%) between 1987 and 2013. Outcome measurement and statistical analyses CVe was defined as onset during the follow-up period of coronary artery disease, cardiomyopathy, hypertension, vasculopathy, heart failure, dysrhythmias, or cerebrovascular disease not known before surgery. Cox regression analyses were performed. To adjust for inherent baseline differences among patients, we performed multivariate analyses adjusting for all available characteristics depicting the overall and cardiovascular-specific profile of the patients. Results and limitations When stratifying for treatment type, the proportion of patients who experienced CVe at 1, 5, and 10 yr was 5.5%, 9.9%, and 20.2% for NSS patients compared to 8.7%, 15.6%, and 25.9%, respectively, for RN patients (p = 0.001). In multivariate analyses, patients who underwent NSS showed a significantly lower risk of developing CVe compared with their RN counterparts (hazard ratio 0.57, 95% confidence interval 0.34-0.96; p = 0.03) after accounting for clinical characteristics and cardiovascular profile. Limitations include the retrospective design of the study because other potential confounders may exist. Conclusions The risk of CVe after renal surgery is not negligible. Patients treated with NSS have roughly half the risk of developing CVe relative to their RN counterparts. After accounting for clinical characteristics, comorbidities, and cardiovascular risk at diagnosis, NSS independently decreases the risk of CVe relative to RN. Patient summary The risk of having a cardiovascular event after renal surgery decreases if a portion of the affected kidney is spared.

KW - Cardiovascular event

KW - Kidney cancer

KW - Nephron-sparing surgery

KW - Overall survival

KW - Partial nephrectomy

KW - Radical nephrectomy

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