Non-Cancer Death Less Likely with Partial Nephrectomy
Patients who undergo partial nephrectomy (PN) for localized renal cell carcinoma (RCC) are more likely to die from causes other than their cancer compared with patients treated with radical nephrectomy (RN), data show.
Maxin Sun, MD, of the University of Montreal Health Center, and colleagues compared other-cause mortality (OCM) among 1,068 PN patients and 1,068 RN patients, adjusting for cancer-specific mortality (CSM), age, baseline Charlson comorbidity index (CCI), race, gender, socioeconomic status, tumor grade, and year of surgery. Subjected were propensity matched.
The two- and five-year OCM rates were 5% and 16%, respectively, for the PN group compared with 6.9% and 18.1% for the RN group. In multivariate analyses, PN patients had a significant 17% decreased likelihood of OCM compared with RN patients, the investigators reported online ahead of print in European Urology.
Additionally, higher CCI, increasing age, female gender, and baseline hypercalcemia and baseline hyperlipidemia were independent predictors of OSM.
As a result of their findings, the researchers concluded that PN should be offered whenever technically feasible.
The authors noted that previous studies have suggested that PN may be associated with increased overall mortality compared with RN. For example, a study by William C. Huang, MD, and colleagues (J Urol 2009;181:55-61) showed that RN was associated with a significant 38% increased risk of overall mortality compared with PN, and a study by Laurent Zini, MD, PhD, and colleagues (Cancer 2009;115:1465-1471) demonstrated a significant 23% increased risk of overall mortality associated with RN compared with PN. Dr. Sun's group pointed out, however, that previous studies have either failed to account for inherent patient and sociodemographic differences between PN and RN patients, did not consider baseline conditions, or did not account for the effect of CSM.