Comparison of oncologic outcomes between elective partial and radical nephrectomy in patients with renal cell carcinoma in CT1B stadium

  • Predrag Marić Military Medical Academy, Clinic for Urology, Belgrade, Serbia
  • Predrag Aleksić Military Medical Academy, Clinic for Urology, Belgrade, Serbia
  • Branko Košević Military Medical Academy, Clinic for Urology, Belgrade, Serbia
  • Mirko Jovanović Military Medical Academy, Clinic for Urology, Belgrade, Serbia
  • Vladimir Bančević Military Medical Academy, Clinic for Urology, Belgrade, Serbia
  • Dejan Simić Military Medical Academy, Clinic for Urology, Belgrade, Serbia
  • Nemanja Rančić University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
Keywords: carcinoma, renal cell, kidney neoplasms, neoplasm metastasis, neoplasms staging, nephrectomy, urologic surgical procedures

Abstract


Background/Aim. In renal cell carcinoma (RCC), the choice of surgical technique, radical (RN) or partial nephrectomy (PN), is still center-dependent because there are still no absolute recommendations for this approach. The aim of this study was to analyze the oncological aspects, time until recurrent disease appears, and cancer-specific survival in patients with RCC in T1bN0М0 stadium depending on the type of surgical procedure, PN or RN technique. Methods. In a clinical observational study, data of 154 patients operated at the Clinic for Urology, Military Medical Academy, Belgrade, Serbia with a mean follow-up period of no less than five years were analyzed. Patients were divided into two groups; a group of patients with RN and a group of patients with PN. The inclusion criteria were: renal tumors 4–7 cm, histopathological confirmation of RCC, absence of metastasis, and normal serum creatinine. Exclusion criteria included: the presence of other malignancies, solitary functional kidney or comorbidities that can compromise renal function, bilateral tumors, or unilateral multiple tumors. Results. The study analyzed data from 154 patients, 97 (63%) RNs, and 57 (37%) patients that underwent PN. Analyzing cancer-specific survival in four patients with RN, there was a disease advancement that led to a lethal outcome, and one PN patient died as a result of local relapse and distant metastasis. Conclusion. Based on our results, PN is a good and safe treatment option for patients with RCC in T1b stadium. PN offers a similar tumor control and better cancer-specific survival.

References

Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin. 2010; 60(5): 277‒300.

Muglia VF, Prando A. Renal cell carcinoma: histological classi-fication and correlation with imaging findings. Radiol Bras 2015; 48(3): 166‒74. (English, Portuguese)

Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Can-cer 2015; 136(5): E359‒86.

Alpres CE, Fogo AB. Kidney and renal collecting system. In: Kumar V, Abbas AK, Fausto N, Mitchell RN, editors. Robbins' Fundamentals of Pathology. Belgrade: Data Status; 2007. p. 541‒77.

Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J, Rosso S, Coebergh JW, Comber H, et al. Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer 2013; 49(6): 1374‒403.

Ljungberg B, Cowan NC, Hanbury DC, Hora M, Kuczyk MA, Merseburger AS, et al. EAU guidelines on renal cell carcinoma: the 2010 update. Eur Urol 2010; 58(3): 398‒406.

Li J, Zhang Y, Teng Z, Han Z. Partial nephrectomy versus radi-cal nephrectomy for cT2 or greater renal tumors: a systematic review and meta-analysis. Minerva Urol Nefrol 2019; 71(5): 435‒44.

Leibovich BC, Blute M, Cheville JC, Lohse CM, Weaver AL, Zincke H. Nephron sparing surgery for appropriately selected renal cell carcinoma between 4 and 7 cm results in outcome similar to radical nephrectomy. J Urol 2004; 171(3): 1066‒70.

Powles T, Staehler M, Ljungberg B, Bensalah K, Canfield SE, Dabestani S, et al. Updated EAU Guidelines for Clear Cell Renal Cancer Patients Who Fail VEGF Targeted Therapy. Eur Urol 2016; 69(1): 4‒6.

Wong MCS, Goggins WB, Yip BHK, Fung FDH, Leung C, Fang Y, et al. Incidence and mortality of kidney cancer: temporal patterns and global trends in 39 countries. Sci Rep 2017; 7(1): 15698.

Eble JN, Sauter G, Epstein JI, Sesterhenn IA. Tumours of the urinary and male genital organs. Lyon: IARC Press; 2004.

Chiong E, Giles RH, Jewett MAS, Murphy DG, Poppel HV, Zar-gar H, et al. The Global burden of CKD: a call for serious ac-tion. Available from: https://worldkidneycancerday.org/wp-content/uploads/2017/05/IKCC-Global-Burden-of-Kidney-Cancer-summary.pdf

Chen DY, Uzzo RG. Optimal management of localized renal cell carcinoma: surgery, ablation, or active surveillance. J Natl Compr Canc Netw 2009; 7(6): 635‒42; quiz 643.

Lai TC, Ma WK, Yiu MK. Partial nephrectomy for T1 renal cancer can achieve an equivalent oncological outcome to radi-cal nephrectomy with better renal preservation: the way to go. Hong Kong Med J 2016; 22(1): 39‒45.

Gershman B, Leibovich BC, Kim SP. Partial versus Radical ne-phrectomy for the Clinical T1a Renal Mass. Eur Urol Focus 2019; 5(6): 970‒2.

Sun M, Trinh QD, Bianchi M, Hansen J, Hanna N, Abdollah F, et al. A non-cancer-related survival benefit is associated with partial nephrectomy. Eur Urol 2012; 61(4): 725‒31.

MacLennan S, Imamura M, Lapitan MC, Omar MI, Lam TB, Hilvano-Cabungcal AM, et al. Systematic review of periopera-tive and quality-of-life outcomes following surgical manage-ment of localised renal cancer. Eur Urol 2012; 62(6): 1097‒117.

Jang HA, Kim JW, Byun SS, Hong SH, Kim YJ, Park YH, et al. Oncologic and Functional Outcomes after Partial nephrecto-my Versus Radical nephrectomy in T1b Renal Cell Carcinoma: A Multicenter, Matched Case-Control Study in Korean Pa-tients. Cancer Res Treat 2016; 48(2): 612‒20.

Larcher A, Capitanio U, Terrone C, Volpe A, De Angelis P, Dehó F, et al. Elective Nephron Sparing Surgery Decreases Other Cause Mortality Relative to Radical nephrectomy Only in Specific Subgroups of Patients with Renal Cell Carcinoma. J Urol 2016; 196(4): 1008‒13.

Shao IH, Kan HC, Liu CY, Lin PH, Yu KJ, Pang ST, et al. Role of Robot-Assisted Partial nephrectomy for Renal Cell Carci-nomas in The Purpose Of Nephron Sparing. Onco Targets Ther 2019; 12: 8189‒96.

Hutson TE. Renal cell carcinoma: diagnosis and treatment, 1994-2003. Proc (Bayl Univ Med Cent) 2005; 18(4): 337‒40.

Ljungberg B, Cowan N, Hanbury DC, Hora M, Kuczyk MA, Mer-seburger AS, et al. Guide to Kidney Cancer. Available from: https://uroweb.org/wp-content/uploads/Renal-Cell-Carcinoma-2011-pocket.pdf.

Jackson G, Fino N, Bitting RL. Clinical Characteristics of Pa-tients with Renal Cell Carcinoma and Metastasis to the Thy-roid Gland. Clin Med Insights Oncol 2017; 11: 1179554917743981.

Herrlinger A, Schott G, Schafhauser W, Schrott KM. The signifi-cance of tumor diameter in renal cell carcinoma. Urologe A 1992; 31(2): 70‒5. (German)

Brookman-May SD, May M, Shariat SF, Novara G, Zigeuner R, Cindolo L, et al. Time to recurrence is a significant predictor of cancer-specific survival after recurrence in patients with recur-rent renal cell carcinoma – results from a comprehensive mul-ti-centre database (CORONA/SATURN-Project). BJU Int 2013; 112(7): 909‒16.

Zhang C, Li X, Hao H, Yu W, He Z, Zhou L. The correlation between size of renal cell carcinoma and its histopathological characteristics: a single center study of 1867 renal cell carci-noma cases. BJU Int 2012; 110(11 Pt B): E481‒5.

Campbell SC, Rini BI. Renal Cell Carcinoma: Clinical Man-agement, Current Clinical Urology. New York: Springer Sci-ence Business Media; 2013.

Madbouly K, Al-Qahtani SM, Ghazwani Y, Al-Shaibani S, Mansi MK. Microvascular tumor invasion: prognostic significance in low-stage renal cell carcinoma. Urology 2007; 69(4): 670‒4.

Antunes AA, Srougi M, Dall'Oglio MF, Crippa A, Paranhos M, Cury J, et al. Microvascular invasion is an independent prog-nostic factor in patients with prostate cancer treated with rad-ical prostatectomy. Int Braz J Urol 2006; 32(6): 668–75; dis-cussion 675–7.

De Luca S, Carrera C, Casalini Vañek E, Alarcón L, Blanchet VL, Eyheremendy EP, et al. Clear cell renal carcinoma with TNM Staging: Radiologic-Pathologic Correlation. ECR 2017. doi: 10.1594/ecr2017/C-2430. Available from: https://dx.doi.org

/10.1594/ecr2017/C-2430

Antonelli A, Cozzoli A, Simeone C, Zani D, Zanotelli T, Portesi E, et al. Surgical treatment of adrenal metastasis from renal cell carcinoma: a single-centre experience of 45 patients. BJU Int 2006; 97(3): 505‒8.

Siemer S, Lehmann J, Kamradt J, Loch T, Remberger K, Humke U, et al. Adrenal metastases in 1635 patients with renal cell car-cinoma: outcome and indication for adrenalectomy. J Urol 2004; 171(6 Pt 1): 21559; discussion 2159.

Saitoh H, Nakayama M, Nakamura K, Satoh T. Distant metasta-sis of renal adenocarcinoma in nephrectomized cases. J Urol 1982; 127(6): 1092‒5.

Bennington JL, Kradjian RM. Distribution of metastasis from renal carcinoma. In: Renal Carcinoma. Chapt. 10. Philadelph-ia: WB Saunders Co; 1999. p. 1952.

Paul R, Mordhorst J, Leyh H, Hartung R. Incidence and outcome of patients with adrenal metastases of renal cell cancer. Urolo-gy 2001; 57(5): 878‒82.

Lau WK, Zincke H, Lohse CM, Cheville JC, Weaver AL, Blute ML. Contralateral adrenal metastasis of renal cell carcinoma: treatment, outcome and a review. BJU Int 2003; 91(9): 775–9.

European Association of Urology. Renal Cell Carcinoma. Available from: http://uroweb.org/guideline/renal-cell-carcinoma/#7

Badalato GM, Kates M, Wisnivesky JP, Choudhury AR, McKiernan JM. Survival after partial and radical nephrectomy for the treatment of stage T1bN0M0 renal cell carcinoma (RCC) in the USA: a propensity scoring approach. BJU Int 2012; 109(10): 1457‒62.

Thompson RH, Siddiqui S, Lohse CM, Leibovich BC, Russo P, Blute ML. Partial versus radical nephrectomy for 4 to 7 cm re-nal cortical tumors. J Urol 2009; 182(6): 2601‒6.

Yang F, Zhou Q, Xing N. Comparison of survival and renal function between partial and radical laparoscopic nephrecto-my for T1b renal cell carcinoma. J Cancer Res Clin Oncol 2020; 146(1): 261‒72.

Mir MC, Derweesh I, Porpiglia F, Zargar H, Mottrie A, Autorino R. Partial nephrectomy Versus Radical nephrectomy for Clini-cal T1b and T2 Renal Tumors: A Systematic Review and Me-ta-analysis of Comparative Studies. Eur Urol 2017; 71(4): 606‒17.

Published
2022/07/13
Section
Original Paper