Comparative effectiveness of adrenal sparing radical nephrectomy and non-adrenal sparing radical nephrectomy in clear cell renal cell carcinoma: Observational study of survival outcomes

Authors

  • Gregory J. Nason Urology Specialist Registrar University Hospital Limerick St. Nessan's Road Limerick Ireland
  • Leon G. Walsh Urology Registrar University Hospital Limerick Limerick Ireland
  • Ciaran E. Redmond Urology Registrar St. Vincent University Hospital Dublin Ireland
  • Niall P. Kelly Urology Registrar University Hospital Limerick Limerick Ireland
  • Barry B. McGuire Urology Fellow Department of Urology, North Western University, Feinberg School of Medicine, Chicago, Illinois, USA
  • Vidit Sharma North Western University, Feinberg School of Medicine, Chicago, Illinois, USA
  • Michael E. Kelly Urology Resident St. Vincent University Hospital Dublin Ireland
  • David J. Galvin Consultant Urological Surgeon St. Vincent University Hospital Dublin Ireland
  • David W. Mulvin Consultant Urological Surgeon St. Vincent University Hospital Dublin Ireland
  • Gerald M. Lennon Consultant Urological Surgeon St. Vincent University Hospital Dublin Ireland
  • David M. Quinlan Consultant Urological Surgeon St. Vincent University Hospital Dublin Ireland
  • Hugh D. Flood Consultant Urological Surgeon University Hospital Limerick St. Nessan's Road Limerick Ireland
  • Subhasis K. Giri Consultant Urological Surgeon University Hospital Limerick St. Nessan's Road Limerick Ireland

DOI:

https://doi.org/10.5489/cuaj.2842

Keywords:

Radical nephrectomy, adrenal sparing, adrenalectomy, survival, clear cell, renal cell carcinoma

Abstract

Introduction: We compare the survival outcomes of patients with clear cell renal cell carcinoma (RCC) treated with adrenal sparing radical nephrectomy (ASRN) and non-adrenal sparing radical nephrectomy (NASRN).

Methods: We conducted an observational study based on a composite patient population from two university teaching hospitals who underwent RN for RCC between January 2000 and December 2012. Only patients with pathologically confirmed RCC were included. We excluded patients undergoing cytoreductive nephrectomy, with loco-regional lymph node involvement. In total, 579 patients (ASRN = 380 and NASRN = 199) met our study criteria. Patients were categorized by risk groups (all stage, early stage and locally advanced RCC). Overall survival (OS) and cancer-specific survival (CSS) were analyzed for risk groups. Survival analysis was performed using Kaplan-Meier curves and Cox proportional hazards regression.

Results: The median follow-up was 41 months (range: 12–157). There were significant benefits in OS (ASRN 79.5% vs. NASRN 63.3%; p = 0.001) and CSS (84.3% vs.74.9%; p = 0.001), with any differences favouring ASRN in all stage. On multivariate analysis, there was a trend towards worse OS (hazard ratio [HR] 1.759, 95% confidence interval [CI] 0.943–2.309, p = 0.089) and CSS (HR 1.797, 95% CI 0.967–3.337, p = 0.064) in patients with NASRN (although not statistically significant). Of these patients, only 11 (1.9%) had adrenal involvement.

Conclusions: The inherent limitations in our study include the impracticality of conducting a prospective randomized trial in this scenario. Our observational study with a 13-year follow-up suggests ASRN leads to better survival than NASRN. ASRN should be considered the gold standard in treating patients with RCC, unless it is contraindicated.

Downloads

Download data is not yet available.

Downloads

Published

2015-09-09

How to Cite

Nason, G. J., Walsh, L. G., Redmond, C. E., Kelly, N. P., McGuire, B. B., Sharma, V., Kelly, M. E., Galvin, D. J., Mulvin, D. W., Lennon, G. M., Quinlan, D. M., Flood, H. D., & Giri, S. K. (2015). Comparative effectiveness of adrenal sparing radical nephrectomy and non-adrenal sparing radical nephrectomy in clear cell renal cell carcinoma: Observational study of survival outcomes. Canadian Urological Association Journal, 9(9-10), E583–8. https://doi.org/10.5489/cuaj.2842

Issue

Vol. 9 No. 9-10 (2015): CUAJ September

Section

Original Research

License

You, the Author(s), assign your copyright in and to the Article to the Canadian Urological Association. This means that you may not, without the prior written permission of the CUA:

  • Post the Article on any Web site
  • Translate or authorize a translation of the Article
  • Copy or otherwise reproduce the Article, in any format, beyond what is permitted under Canadian copyright law, or authorize others to do so
  • Copy or otherwise reproduce portions of the Article, including tables and figures, beyond what is permitted under Canadian copyright law, or authorize others to do so.

The CUA encourages use for non-commercial educational purposes and will not unreasonably deny any such permission request.

You retain your moral rights in and to the Article. This means that the CUA may not assert its copyright in such a way that would negatively reflect on your reputation or your right to be associated with the Article.

The CUA also requires you to warrant the following:

  • That you are the Author(s) and sole owner(s), that the Article is original and unpublished and that you have not previously assigned copyright or granted a licence to any other third party;
  • That all individuals who have made a substantive contribution to the article are acknowledged;
  • That the Article does not infringe any proprietary right of any third party and that you have received the permissions necessary to include the work of others in the Article; and
  • That the Article does not libel or violate the privacy rights of any third party.