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Impact of Radical Nephrectomy and Partial Nephrectomy on Actual Estimated Overall Survival Compared to Life Expectancy in Patients with Renal Cell Carcinoma

Authors Hori S, Tanaka N, Iida K, Nakai Y, Miyake M, Anai S, Torimoto K, Fujimoto K

Received 16 January 2021

Accepted for publication 11 March 2021

Published 24 March 2021 Volume 2021:13 Pages 155—165


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Jan Colli

Shunta Hori, Nobumichi Tanaka, Kota Iida, Yasushi Nakai, Makito Miyake, Satoshi Anai, Kazumasa Torimoto, Kiyohide Fujimoto

Department of Urology, Nara Medical University, Kashihara, Nara, 634-8522, Japan

Correspondence: Nobumichi Tanaka
Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
Tel +81-744-22-3051
Fax +81-744-22-9282
Email [email protected]

Purpose: Reports suggest that partial nephrectomy provides no significant benefit in terms of cancer-specific and overall survival (OS) compared to radical nephrectomy. Here, we focused on survival in terms of life expectancy and investigated the significance of partial nephrectomy for localized renal cell carcinoma (RCC) patients.
Patients and Methods: Our retrospective study included 937 patients (median age 63 years) with localized RCC who underwent partial nephrectomy or radical nephrectomy. Various predictive factors were explored, and the association between actual OS and life expectancy was analyzed.
Results: Performance status (PS) ≥ 1 and tumor size ≥ 40 mm were identified as independent poor prognostic factors for cancer-specific survival. Age ≥ 60, male sex, PS ≥ 1, C-reactive protein elevation, pT1b stage, and radical nephrectomy were identified as independent poor prognostic factors for OS. OS and life expectancy did not differ in the partial nephrectomy group (P=0.11). OS was significantly shorter than life expectancy in the radical nephrectomy group (P< 0.0001). In PS0 or pT1a patients, there was a significant difference between actual OS and life expectancy in the radical nephrectomy group (P< 0.0001), but not in the partial nephrectomy group (P=0.15). In patients with a life expectancy ≥ 10 years, PS0, and pTa, OS and life expectancy differed in the radical nephrectomy group, but not in the partial nephrectomy group.
Conclusion: Partial nephrectomy can improve actual OS, and notably, PS and tumor size are crucial factors that determine the choice of surgical procedure. Further research is needed to establish appropriate treatment strategies and criteria for clinical practice.

Keywords: life expectancy, nephrectomy, performance status, renal cell carcinoma, tumor size

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