Antonelli, A.

Bertini, R.

Capitanio, U.

Carini, Marco

Di Domenico, A.

Di Trapani, E.

Furlan, M.

Minervini, Andrea

Montorsi, F.

Porpiglia, F.

Salonia, A.

Simeone, Felice Carlo

Terrone, C.

English

Florence Research

Titlefile:///S|/IM/EURSUP/2015%20EAU%20Abstracts/content/data/107.html[19/02/2015 08:06:12]107 Nephron-sparing surgery protects from chronic kidney disease relative to radical nephrectomybut does not impact on other-causes mortality: Long-term (more than 10 years) survival andfunctional outcomes in patients with a T1a-T1b renal massEur Urol Suppl 2015;14/2;e107         Print!Capitanio U.1, Terrone C.2, Antonelli  A.3, Minervini A.4, Porpiglia F.5, Di Domenico A.2, Furlan M.3, Di Trapani E.1, Salonia A.1, CariniM.4, Simeone C.3, Montorsi F.1, Bertini R.11San Raffaele Scientific Institute, Dept. of Urology, Milan, Italy, 2University of Piemonte Orientale, Dept. of Urology, Novara, Italy,3Universita' Degli Studi E Spedali Civili, Dept. of Urology, Brescia, Italy, 4Clinica Urologica I, Azienda Ospedaliera Universitaria Careggi,Dept. of Urology, Florence, Italy, 5San Luigi Hospital-Orbassano, Dept. of Urology, Turin, ItalyINTRODUCTION & OBJECTIVES: Several reports demonstrated that nephron sparing surgery (NSS) better protects renal function relativeto radical nephrectomy (RN). However, controversies exist whether NSS may also affect other-cause mortality (OCM). In the current study,we aimed to report the long term (more than 10 years) survival and functional outcomes of NSS vs. RN after accounting for clinicalcharacteristics, comorbidities and individual patients' cardiovascular risk.MATERIAL & METHODS: A multi-institutional collaboration among five European Tertiary Care Centers allowed collecting 1189 patientswith a clinical T1a-T1b N0 M0 renal mass and treated between 1988 and 2004. Patients underwent RN (n=678, 57%) or NSS (n=511, 43%)and showed normal estimated glomerular filtration rates (eGFR) before surgery (defined as a pre-operative eGFR≥60ml/min/1.73m2).Descriptive, univariable and multivariable Cox regression analyses were used to predict the risk of OCM and chronic kidney disease (CKD,defined as post-operative GFR<60ml/min/1.73m2). To adjust for inherent baseline differences among patients, we included as covariates:age, pre-operative GFR, clinical tumor size, hypertension (none vs. yes vs. controlled by medical therapy), diabetes, baseline Charlsoncomorbidity index (CCI), body mass index and smoker status (no vs. yes vs. former).RESULTS: Median follow up period was 10 years (interquartile range, IQR 6-13 yrs). Median age was 61 yrs (IQR 51-68) and medianclinical tumor size 4 cm (IQR 3-5). Sixty-six (5.6%) patients had diabetes. Overall, 141 (11.9%) and 154 (13.0%) patients had hypertensionor hypertension controlled by medical therapy, respectively. CCI resulted 2 or higher in 21% of the cases. The 5 yr, 10 yr and 15 yr CKD rates after surgery were 6.3%, 16.4% and 42.3% for NSS vs. 13.2%, 28.4% and 48.9% for RN, respectively(p=0.002, hazard ratio HR 0.65 95%CI 0.49-0.85). At multivariable analyses, patients who underwent NSS showed significantly lower risk toharbour CKD compared with their RN-treated counterparts (p=0.01, HR 0.65; 95% confidence interval, 0.47-0.92).The 5 yr, 10 yr and 15 yr OCM rates after surgery were 6.0%, 14.0% and 26.6% for NSS vs. 7.3%, 14.2% and 22.5% for RN, respectively(p=0.6, HR 1.08 95%CI 0.80-1.46). At multivariable analyses, after accounting for clinical characteristics, comorbidities and individualcardiovascular risk, patients who underwent NSS showed similar risk to die for OCM compared with their RN-treated counterparts (p=0.8,HR 0.97 95%CI 0.67-1.40).CONCLUSIONS: When considering long-term survival and functional outcomes in patients with a clinical T1a-T1b mass and normal renalfunction before surgery, NSS protects from CKD but does not impact on OCM relative to RN.

Nephron-sparing surgery protects from chronic kidney disease relative to radical nephrectomy

but does not impact on other-causes mortality: Long-term (more than 10 years) survival and

functional outcomes in patients with a T1a-T1b renal mass

https://flore.unifi.it/bitstream/2158/1056694/1/107-Nephron-sparing-surgery-protects-from-chronic-kidney-disease-relative-to-radical-nephrectomy-but-does-not-impact-on-other-causes-mortality-Long-te%20-%20Copia.pdf

Nephron-sparing surgery protects from chronic kidney disease relative to radical nephrectomy but does not impact on other-causes mortality: Long-term (more than 10 years) survival and functional outcomes in patients with a T1a-T1b renal mass

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