L. Zini

Radical versus partial nephrectomy: effect on overall and noncancer mortality.

Relative to radical nephrectomy (RN), partial nephrectomy (PN) performed for renal cell carcinoma (RCC) may protect from non‐cancer‐related deaths. The authors tested this hypothesis in a cohort of PN and RN patients.

A population based assessment of perioperative mortality after cystectomy for bladder cancer.

PURPOSEnLarge variability exists in the rates of perioperative mortality after cystectomy. Contemporary estimates range from 0.7% to 5.6%. We tested several predictors of perioperative mortality and devised a model for individual perioperative mortality prediction.nnnMATERIALS AND METHODSnWe relied on life tables to quantify 30, 60 and 90-day mortality rates according to age, gender, stage (localized vs regional), grade, type of surgery (partial vs radical cystectomy), year of cystectomy and histological bladder cancer subtype. We fitted univariable and multivariable logistic regression models using 5,510 patients diagnosed with bladder cancer and treated with partial or radical cystectomy within 4 SEER (Surveillance, Epidemiology, and End Results) registries between 1984 and 2004. We then externally validated the model on 5,471 similar patients from 5 other SEER registries.nnnRESULTSnAt 30, 60 and 90 days the perioperative mortality rates were 1.1%, 2.4% and 3.9%, respectively. Age, stage and histological subtype represented statistically significant and independent predictors of 90-day mortality. The combined use of these 3 variables and of tumor grade resulted in the most accurate model (70.1%) for prediction of individual probability of 90-day mortality after cystectomy.nnnCONCLUSIONSnThe accuracy of our model could potentially be improved with the consideration of additional parameters such as surgical and hospital volume or comorbidity. While better models are being developed and tested we suggest the use of the current model in individual decision making and in informed consent considerations because it provides accurate predictions in 7 of 10 patients.

Population-based Assessment of Survival After Cytoreductive Nephrectomy Versus No Surgery in Patients With Metastatic Renal Cell Carcinoma

OBJECTIVESnTo examine the population-based survival rates of patients with metastatic renal cell carcinoma (RCC) treated with cytoreductive nephrectomy (CNT) and compare them with those of patients treated without surgery.nnnMETHODSnOf the 43,143 patients with RCC identified in the 1988-2004 Surveillance, Epidemiology, and End Results database, 5372 had metastatic RCC. Of those, 2447 were treated with CNT (45.5%) and 2925 (54.5%) were not. Univariable and multivariable Cox regression models, as well as matched and unmatched Kaplan-Meier survival analyses, were used. The covariates consisted of age, sex, tumor size, and year of diagnosis.nnnRESULTSnThe 1-, 2-, 5-, and 10-year overall survival rate of the patients treated with CNT was 53.6%, 36.3%, 19.4%, and 12.7% compared with 18.5%, 7.4%, 2.3%, and 1.2% for the no-surgery patients, respectively. The corresponding cancer-specific survival rates were 58.1%, 40.8%, 24.3%, and 18.8% and 24.4%, 11.0%, 4.1%, and 2.9% for the same patient groups. On multivariate analysis, independent predictor status was recorded for treatment type, tumor size, and patient age (all P <.001). Also, relative to CNT, the no-surgery group had a 2.5-fold greater rate of overall and cancer-specific mortality (P <.001). In the matched analyses, virtually the same effect was recorded (hazard ratio 2.6, P <.001).nnnCONCLUSIONnThe results of our study have shown that CNT significantly improves the survival of patients with metastatic RCC.

The use of partial nephrectomy in European tertiary care centers.

PURPOSEnThe objective was to define the trends of PN use over time at six tertiary care European centers.nnnMETHODSnData were retrieved from institutional databases for patients treated with either PN or radical nephrectomy (RN) for stages T(1-2)N(0)M(0) renal cell carcinoma (RCC) between 1987 and 2007. For purpose of temporal trend analyses patients were divided into five equally sized groups according to the date of surgery. Categorical and multivariable logistic regression analyses assessed predictors of PN use.nnnRESULTSnOverall 597 (31.7%) patients were treated with PN. Overall, a 4.5-fold increase of PN was recorded. The absolute increases were 41.7-86.3%, 14.9-69.3% and 8.1-35.3% for lesions < or = 2 cm, 2.1-4 cm and 4.1-7 cm (chi-square trend test p<0.001), respectively. In multivariable logistic regression models, decreasing tumor size, younger age, more contemporary date of surgery, male gender and institutional PN rate represented independent predictors of the individual probability of treatment with PN. Lack of data from community hospitals limits the generalizability of our findings.nnnCONCLUSIONnBased on data from six tertiary care centers, the contemporary rate of PN ranges from 86 to 35% for renal masses < or = 2 cm to 4.1-7 cm and is indicative of excellent quality of care.

Stage-specific effect of nodal metastases on survival in patients with non-metastatic renal cell carcinoma

To quantify the survival disadvantage related to the presence of exclusive nodal metastases (eNM) in patients with otherwise non‐metastatic (M0) renal cell carcinoma (RCC).

Thirty-day mortality after nephrectomy: clinical implications for informed consent.

BACKGROUNDnThe existing literature suggests that the surgical mortality (SM) observed with nephrectomy for localised disease varies from 0.6% to 3.6%.nnnOBJECTIVEnTo examine age- and stage-specific 30-d mortality (TDM) rates after partial or radical nephrectomy.nnnDESIGN, SETTING, AND PARTICIPANTSnWe relied on 24535 assessable patients from the National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results (SEER) database.nnnMEASUREMENTSnIn 12283 patients, logistic regression models were used to develop a tool for pretreatment prediction of the probability of TDM according to individual patient and tumour characteristics. External validation was performed on 12252 patients.nnnRESULTS AND LIMITATIONSnIn the entire cohort of 24535 patients, 219 deaths occurred during the initial 30 d after nephrectomy (0.9% TDM rate). TDM increased with age (≤49 yr: 0.5% vs 50-59 yr: 0.7% vs 60-69 yr: 0.9% vs 70-79 yr: 1.2% vs ≥80 yr: 2.0%; χ(2) trend p<0.001) and stage (0.3% for T1-2N0M0 vs 1.3% for T3-4N0-2M0 vs 4.2% for T1-4N0-2M1; χ2 trend p=<0.001). TDM decreased in more recent years (1988-1993: 1.3% vs 1994-1998: 0.9% vs 1999-2002: 0.7% vs 2003-2004: 0.6%; χ2 trend p<0.001) and was lower after partial versus radical nephrectomy (RN) (0.4% vs 0.9%; p=0.008). Only age (p<0.001) and stage (p<0.001) achieved independent predictor status. The look-up table that relied on the regression coefficients of age and stage reached 79.4% accuracy in the external validation cohort.nnnCONCLUSIONSnAge and stage are the foremost determinants of TDM after nephrectomy. Our model provides individual probabilities of TDM after nephrectomy, and its use should be highly encouraged during informed consent prior to planned nephrectomy.

Partial cystectomy does not undermine cancer control in appropriately selected patients with urothelial carcinoma of the bladder: a population-based matched analysist.

OBJECTIVESnCancer control outcomes after partial cystectomy (PC) are not well studied. We compared the population-based rates of overall (OS) and cause-specific survival (CSS) in patients with urothelial carcinoma of the urinary bladder (UCB) treated with PC or radical cystectomy (RC).nnnMETHODSnWithin the Surveillance Epidemiology and End Results-9 database, we identified 7243 patients treated with PC (n = 1573) or RC (n = 5670), who had pathologic T(1-4)N(1-2)M(0) UCB. Matched Kaplan-Meier survival analyses compared the effect of PC vs RC on OS and CSS.nnnRESULTSnIn the entire cohort, the OS and CSS estimates at 5 years were 57.2% and 76.4%, respectively, for PC patients and 50.2% and 65.8%, respectively, for RC patients (P < .001). In the cohort matched for age, race, pT stage, pN stage, tumor grade, and year of surgery, at 5 years the OS and CSS estimates were 56.0% and 73.5%, respectively, for PC patients, and 50.9% and 67.5%, respectively, for RC patients (OS, P = .03 and CSS, P < .001). When the number of removed lymph nodes was added to the matching criteria, the 5-year OS and CSS estimates were 57.2% and 70.3%, respectively, for PC patients, and 54.6% and 69.2%, respectively, for RC patients (HR 1.1, P = .3 and HR 1.1, P = .5).nnnCONCLUSIONSnPartial cystectomy does not undermine cancer control in appropriately selected patients with UCB.

Cancer-specific and non-cancer-related mortality rates in European patients with T1a and T1b renal cell carcinoma

To examine cancer‐specific and non‐cancer‐related mortality rates in 451 patients with T1a–bN0M0 renal cell carcinoma (RCC) treated with either radical or partial nephrectomy (RN or PN) in Europe.

External Validation of the Updated Partin Tables in a Cohort of French and Italian Men

PURPOSEnTo test the discrimination and calibration properties of the newly developed 2007 Partin Tables in two European cohorts with localized prostate cancer.nnnMETHODSnData on clinical and pathologic characteristics were obtained for 1,064 men treated with radical prostatectomy at the Creteil University Health Center in France (n = 839) and at the Milan University Vita-Salute in Italy (n = 225). Overall discrimination was assessed with receiver operating characteristic curve analysis, which quantified the accuracy of stage predictions for each center. Calibration plots graphically explored the relationship between predicted and observed rates of extracapsular extension (ECE), seminal vesicle invasion (SVI) and lymph node invasion (LNI).nnnRESULTSnThe rates of ECE, SVI, and LNI were 28%, 14%, and 2% in the Creteil cohort vs. 11%, 5%, and 5% in the Milan cohort. In the Creteil cohort, the accuracy of ECE, SVI, and LNI prediction was 61%, 71%, and 82% vs. 66%, 92% and 75% for the Milan cohort. Important departures were recorded between Partin Tables predicted and observed rates of ECE, SVI, and LNI within both cohorts.nnnCONCLUSIONSnThe 2007 Partin Tables demonstrated worse performance in European men than they originally did in North American men. This indicates that predictive models need to be externally validated before their implementation into clinical practice.

Baseline renal function, ischaemia time and blood loss predict the rate of renal failure after partial nephrectomy.

To identify independent predictors of renal failure after partial nephrectomy (PN) in patients with renal cell carcinoma (RCC).