During the study period between 2000 and 2002, patients who underwent partial nephrectomy experienced fewer adverse renal outcomes (16.4% vs. 21.8%), with a trend toward less frequent use of dialysis and a decreased need for dialysis access surgery or renal transplantation. However, there were no differences between the two surgeries in terms of cardiovascular outcomes.
Nevertheless, Dr. Gore noted that a European study from 2011 that examined overall survival did not support these findings.6 This study included 268 patients who received partial nephrectomy and 273 who received radical nephrectomy, all with tumors smaller than 5 cm. The median follow-up for this study was 9.3 years.
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The study concluded that the 10-year overall survival (OS) rates were better for patients who underwent radical nephrectomy (81.1%) compared to patients who underwent partial nephrectomy (75.7%). Dr. Gore said it is important to note that these patients were recruited between March 1992 and January 2003.. “Those patients were treated in the late 1990s and early 2000s when people didn’t have as much technical experience with partial nephrectomy,” said Dr. Gore.
To better investigate this issue, Dr. Gore and his colleagues recently performed a retrospective cohort study of Medicare beneficiaries with clinical stage T1a kidney cancer treated with either partial or radical nephrectomy.7 The 7,138 Medicare beneficiaries were treated between 1992 and 2007; 27% underwent partial nephrectomy and 73% underwent radical nephrectomy. The study evaluated OS rates and had a median follow-up of 62 months.
The study showed that treatment with partial nephrectomy in elderly patients was superior; patients who underwent partial nephrectomy had a 5.6% survival advantage 2 years after surgery and 15.5% survival advantage 8 years after surgery. Dr. Gore noted there are benefits with partial nephrectomy compared to radical nephrectomy.
“The benefit of partial nephrectomy is not that it is a better cancer treatment. It is an equivalent cancer treatment. The adjunctive benefit is the reduction of patients’ renal and cardiovascular morbidity,” said Dr. Gore in an interview with ChemotherapyAdvisor.com. “The kidney cancer survival was equivalent but we showed that as you distance patients from their treatment, the benefit of partial nephrectomy over radical nephrectomy increases.”
References
1) Najjar YG, Elson P, Wood LS, et al. Association of a 2-weeks-on and 1-week-off schedule of sunitinib with decreased toxicity in metastatic renal cell carcinoma a week-off schedule of sunitinib with decreased toxicity in metastatic renal cell carcinoma[ASCO GU abstract 406]. J Clin Oncol. 2013;31(suppl 6):abstract 406.
2) Nakamura K, Taguchi E, Miura T, et al. KRN951, a highly potent inhibitor of vascular endothelial growth factor receptor tyrosine kinases, has antitumor activities and affects functional vascular properties. Cancer Res. 2006;66:9134–9142.
3) Motzer RJ, Nosov D, Eisen T, et al. Tivozanib versus sorafenib as initial targeted therapy for patients with advanced renal cell carcinoma: Results from a phase III randomized, open-label, multicenter trial. J Clin Oncol. 2012;30 (suppl):abstract 4501.
4) Motzer RJ, Nosov D, Tomczak P, et al. Efficacy and safety data from patients with advanced renal cell cancer treated with tivozanib hydrochloride after progression on sorafenib. J Clin Oncol. 2013;31(suppl 6):abstract 364.
5) Miller DC, Schonlau M, Litwin MS, et al. Renal and cardiovascular morbidity after partial or radical nephrectomy. Cancer. 2008 Feb 1;112(3):511-520.
6) Van Poppel H. Da Pozzo L, Albrecht W, et al. A prospective randomized EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol. 2011 Apr:59(4):543-552.
7) Tan HJ, Norton EC, Ye Z, et al. Long-term survival following partial vs. radical nephrectomy among older patients with early-stage kidney cancer. JAMA. 2012 Apr 18;307(15):1629-1635.
