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Partial versus Radical Nephrectomy for T1-T2 Renal Cell Carcinoma in Patients with Chronic Kidney Disease Stage III: a Multiinstitutional Analysis of Kidney Function and Survival Rate

BACKGROUND: To examine survival rates and renal function after partial nephrectomy (PN) and radical nephrectomy (RN) in patients with chronic kidney disease (CKD). METHODS: We studied 4,332 patients who underwent PN or RN for pathological T1a-T2N0M0 renal cell carcinoma from 1988 to 2014. Patients w...

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Autores principales: Chung, Jae-Seung, Son, Nak Hoon, Lee, Sang Eun, Hong, Sung Kyu, Jeong, Chang Wook, Kwak, Cheol, Kim, Hyeon Hoe, Hong, Sung Hoo, Kim, Yong June, Kang, Seok Ho, Chung, Jinsoo, Kwon, Tae Gyun, Hwang, Eu Chang, Byun, Seok-Soo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Academy of Medical Sciences 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6193884/
https://www.ncbi.nlm.nih.gov/pubmed/30344463
http://dx.doi.org/10.3346/jkms.2018.33.e277
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author Chung, Jae-Seung
Son, Nak Hoon
Lee, Sang Eun
Hong, Sung Kyu
Jeong, Chang Wook
Kwak, Cheol
Kim, Hyeon Hoe
Hong, Sung Hoo
Kim, Yong June
Kang, Seok Ho
Chung, Jinsoo
Kwon, Tae Gyun
Hwang, Eu Chang
Byun, Seok-Soo
author_facet Chung, Jae-Seung
Son, Nak Hoon
Lee, Sang Eun
Hong, Sung Kyu
Jeong, Chang Wook
Kwak, Cheol
Kim, Hyeon Hoe
Hong, Sung Hoo
Kim, Yong June
Kang, Seok Ho
Chung, Jinsoo
Kwon, Tae Gyun
Hwang, Eu Chang
Byun, Seok-Soo
author_sort Chung, Jae-Seung
collection PubMed
description BACKGROUND: To examine survival rates and renal function after partial nephrectomy (PN) and radical nephrectomy (RN) in patients with chronic kidney disease (CKD). METHODS: We studied 4,332 patients who underwent PN or RN for pathological T1a-T2N0M0 renal cell carcinoma from 1988 to 2014. Patients were divided into two subgroups of CKD stage I–II and stage III. Kidney function, and survival outcomes were compared between groups. RESULTS: We included 1,756 patients with CKD I–II and 276 patients with CKD III in the final pair-matched analysis. Kidney function was significantly better preserved in the PN than in the RN group among all patients. However, the beneficial effect of PN on kidney function gradually disappeared over time in CKD III patients. The 5-year overall survival (OS) rates after PN and RN differed in patients with CKD I–II disease (99.4% vs. 96.5%, respectively, P = 0.015). The 5-year OS rates after surgery were not affected by mode of nephrectomy in CKD III patients (97.8% vs. 93.5%, P = 0.103). The 5-year cancer-specific survival rates did not differ between treatment groups in all CKD stage. Cox hazard analysis showed that the operative method was a significant factor for OS in CKD I–II patients (hazard ratio [HR], 0.320; confidence interval [CI], 0.122–0.840; P = 0.021). However, PN was not beneficial in terms of OS in CKD III patients (HR, 0.395; CI, 0.086–1.172; P = 0.117). CONCLUSION: PN is associated with a higher OS rate and better kidney function in patients with preoperative CKD stage I and II, but not in those with CKD stage III.
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spelling pubmed-61938842018-10-22 Partial versus Radical Nephrectomy for T1-T2 Renal Cell Carcinoma in Patients with Chronic Kidney Disease Stage III: a Multiinstitutional Analysis of Kidney Function and Survival Rate Chung, Jae-Seung Son, Nak Hoon Lee, Sang Eun Hong, Sung Kyu Jeong, Chang Wook Kwak, Cheol Kim, Hyeon Hoe Hong, Sung Hoo Kim, Yong June Kang, Seok Ho Chung, Jinsoo Kwon, Tae Gyun Hwang, Eu Chang Byun, Seok-Soo J Korean Med Sci Original Article BACKGROUND: To examine survival rates and renal function after partial nephrectomy (PN) and radical nephrectomy (RN) in patients with chronic kidney disease (CKD). METHODS: We studied 4,332 patients who underwent PN or RN for pathological T1a-T2N0M0 renal cell carcinoma from 1988 to 2014. Patients were divided into two subgroups of CKD stage I–II and stage III. Kidney function, and survival outcomes were compared between groups. RESULTS: We included 1,756 patients with CKD I–II and 276 patients with CKD III in the final pair-matched analysis. Kidney function was significantly better preserved in the PN than in the RN group among all patients. However, the beneficial effect of PN on kidney function gradually disappeared over time in CKD III patients. The 5-year overall survival (OS) rates after PN and RN differed in patients with CKD I–II disease (99.4% vs. 96.5%, respectively, P = 0.015). The 5-year OS rates after surgery were not affected by mode of nephrectomy in CKD III patients (97.8% vs. 93.5%, P = 0.103). The 5-year cancer-specific survival rates did not differ between treatment groups in all CKD stage. Cox hazard analysis showed that the operative method was a significant factor for OS in CKD I–II patients (hazard ratio [HR], 0.320; confidence interval [CI], 0.122–0.840; P = 0.021). However, PN was not beneficial in terms of OS in CKD III patients (HR, 0.395; CI, 0.086–1.172; P = 0.117). CONCLUSION: PN is associated with a higher OS rate and better kidney function in patients with preoperative CKD stage I and II, but not in those with CKD stage III. The Korean Academy of Medical Sciences 2018-10-01 /pmc/articles/PMC6193884/ /pubmed/30344463 http://dx.doi.org/10.3346/jkms.2018.33.e277 Text en © 2018 The Korean Academy of Medical Sciences. https://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Chung, Jae-Seung
Son, Nak Hoon
Lee, Sang Eun
Hong, Sung Kyu
Jeong, Chang Wook
Kwak, Cheol
Kim, Hyeon Hoe
Hong, Sung Hoo
Kim, Yong June
Kang, Seok Ho
Chung, Jinsoo
Kwon, Tae Gyun
Hwang, Eu Chang
Byun, Seok-Soo
Partial versus Radical Nephrectomy for T1-T2 Renal Cell Carcinoma in Patients with Chronic Kidney Disease Stage III: a Multiinstitutional Analysis of Kidney Function and Survival Rate
title Partial versus Radical Nephrectomy for T1-T2 Renal Cell Carcinoma in Patients with Chronic Kidney Disease Stage III: a Multiinstitutional Analysis of Kidney Function and Survival Rate
title_full Partial versus Radical Nephrectomy for T1-T2 Renal Cell Carcinoma in Patients with Chronic Kidney Disease Stage III: a Multiinstitutional Analysis of Kidney Function and Survival Rate
title_fullStr Partial versus Radical Nephrectomy for T1-T2 Renal Cell Carcinoma in Patients with Chronic Kidney Disease Stage III: a Multiinstitutional Analysis of Kidney Function and Survival Rate
title_full_unstemmed Partial versus Radical Nephrectomy for T1-T2 Renal Cell Carcinoma in Patients with Chronic Kidney Disease Stage III: a Multiinstitutional Analysis of Kidney Function and Survival Rate
title_short Partial versus Radical Nephrectomy for T1-T2 Renal Cell Carcinoma in Patients with Chronic Kidney Disease Stage III: a Multiinstitutional Analysis of Kidney Function and Survival Rate
title_sort partial versus radical nephrectomy for t1-t2 renal cell carcinoma in patients with chronic kidney disease stage iii: a multiinstitutional analysis of kidney function and survival rate
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6193884/
https://www.ncbi.nlm.nih.gov/pubmed/30344463
http://dx.doi.org/10.3346/jkms.2018.33.e277
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