MP59-20 MULTICENTER ANALYSIS OF ONCOLOGIC AND RENAL FUNCTIONAL OUTCOMES OF RADICAL AND PARTIAL NEPHRECTOMY IN STAGE II RENAL CELL CARCINOMA (2017)

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy IV1 Apr 2017MP59-20 MULTICENTER ANALYSIS OF ONCOLOGIC AND RENAL FUNCTIONAL OUTCOMES OF RADICAL AND PARTIAL NEPHRECTOMY IN STAGE II RENAL CELL CARCINOMA Zachary Hamilton, Andres Correa, Alessandro Larcher, Zineddine Khene, Katherine Fero, Daniel Han, Aaron Bloch, Charles Field, Benoit Peyronnet, Umberto Capitanio, Francesco Montorsi, Karim Bensalah, Robert Uzzo, and Ithaar Derweesh Zachary HamiltonZachary Hamilton More articles by this author , Andres CorreaAndres Correa More articles by this author , Alessandro LarcherAlessandro Larcher More articles by this author , Zineddine KheneZineddine Khene More articles by this author , Katherine FeroKatherine Fero More articles by this author , Daniel HanDaniel Han More articles by this author , Aaron BlochAaron Bloch More articles by this author , Charles FieldCharles Field More articles by this author , Benoit PeyronnetBenoit Peyronnet More articles by this author , Umberto CapitanioUmberto Capitanio More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Karim BensalahKarim Bensalah More articles by this author , Robert UzzoRobert Uzzo More articles by this author , and Ithaar DerweeshIthaar Derweesh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1836AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES While partial nephrectomy (PN) is an accepted standard for small renal mass, utilization for large (>7cm) renal mass is controversial. We conducted a comparative analysis of survival and functional outcomes of PN and radical nephrectomy (RN) for clinical T2 Renal Mass (cT2RM). METHODS Retrospective international multicenter analysis of PN and RN for cT2RM (T2N0M0) from 1987-2016. Primary outcome was change in glomerular filtration rate (delta eGFR). Secondary outcomes were de novo Stage 3 Chronic Kidney Disease (CKD, eGFR<60), eGFR<45 at last follow up, overall survival (OS), and complication rates. Multivariable (MV) logistic regression was used for outcomes, and Kaplan-Meier (KM) curves were created for OS. RESULTS Study cohort with 1125 patients (239 PN, 886 RN), mean age 60.3 years, median follow up 38.9 months, mean clinical tumor size 9.9 cm, 70.5% cT2a / 29.5% cT2b. PN had higher BMI (29.6 vs. 27.3, p<0.001), as well as higher rate of hypertension (HTN, 59% vs. 47%, p=0.001) and diabetes (DM, 20.9% vs. 13.4%, p=0.005). RN cohort had larger tumor size (10.0 vs. 9.2 cm, p<0.001) and more cT2b disease (32.6% vs. 18.0%, p<0.001). Mean ischemia time for PN was 34.6 min. No significant differences were noted in hospital stay (p=0.697) or 30 day complications (36.0% vs. 36.9%, p=0.821). RN had higher all-cause mortality rate (32.6% vs. 13.4%, p<0.001). KM analysis revealed 5 year OS of 66.9% for RN and 82.2% for PN (p<0.001). KM stratified by cT stage PN vs. RN revealed 5 year OS for cT2a (83.2% vs. 70.1%, p=0.004) and for cT2b (84.6% vs. 60.2%, p=0.003) (figure). Preoperative eGFR was similar (79.4 vs. 77.3, p=0.23), and mean delta eGFR was higher for RN (-20.2 vs. -10.4, p<0.001). RN had worsened renal functional outcomes with respect to de novo GFR <60 (51.2% vs. 28.9%, p<0.001) and de novo GFR <45 (22.8% vs. 14.0%, p<0.001). MV Cox model for OS was significant for age (HR 1.02, p<0.001), DM (HR 1.54, p=0.021), tumor grade 3/4 (HR 2.22, p<0.001), lymphovascular invasion (LVI, HR 1.74, p=0.001), and RN (HR 3.24, p<0.001). CONCLUSIONS PN when performed in the setting of cT2RM provides renal functional benefit and may have survival benefit. Consideration may be given to PN when technically feasible for cT2RM in appropriately selected patients. Prospective data are requisite to confirm. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e789 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Zachary Hamilton More articles by this author Andres Correa More articles by this author Alessandro Larcher More articles by this author Zineddine Khene More articles by this author Katherine Fero More articles by this author Daniel Han More articles by this author Aaron Bloch More articles by this author Charles Field More articles by this author Benoit Peyronnet More articles by this author Umberto Capitanio More articles by this author Francesco Montorsi More articles by this author Karim Bensalah More articles by this author Robert Uzzo More articles by this author Ithaar Derweesh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...