Survival rates after resection for localized kidney cancer: 1989 to 2004

BACKGROUND. Mortality rates from kidney cancer have continued to rise despite increases in the detection of smaller renal tumors and rates of renal surgery. To explore the factors associated with this treatment‐outcome discrepancy, the authors evaluated how changes in tumor size have affected diseas...

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Published in:Cancer 2008-07, Vol.113 (1), p.84-96
Main Authors: Russo, Paul, Jang, Thomas L., Pettus, Joseph A., Huang, William C., Eggener, Scott E., O'Brien, Matthew F., Karellas, Michael E., Karanikolas, Nicholas T., Kagiwada, Megan A.
Format: Article
Language:English
Subjects:
adrenalectomy
Biological and medical sciences
Carcinoma, Renal Cell - mortality
Carcinoma, Renal Cell - pathology
Carcinoma, Renal Cell - surgery
Disease-Free Survival
Female
Humans
Kidney Neoplasms - mortality
Kidney Neoplasms - pathology
Kidney Neoplasms - surgery
Kidneys
lymph node dissection
Male
Medical sciences
nephrectomy
Nephrectomy - trends
Nephrology. Urinary tract diseases
overall survival
pathologic tumor classification
progression‐free survival
Survival Rate
Time Factors
tumor size
Tumors
Tumors of the urinary system
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Summary:BACKGROUND. Mortality rates from kidney cancer have continued to rise despite increases in the detection of smaller renal tumors and rates of renal surgery. To explore the factors associated with this treatment‐outcome discrepancy, the authors evaluated how changes in tumor size have affected disease progression in patients after nephrectomy for localized kidney cancer, and they sought to identify the factors associated with disease progression and overall patient survival after resection for localized kidney cancer. METHODS. In total, 1618 patients with localized kidney cancer were identified who underwent nephrectomy at Memorial Sloan‐Kettering Cancer Center from 1989 to 2004. Patients were categorized by year of surgery: from 1989 to 1992, from 1993 to 1996, from 1997 to 2000, and from 2001 to 2004. Tumor size was classified according to the following strata: 7 cm. Disease progression was defined as the development of local recurrence or distant metastases. Five‐year progression‐free survival (PFS) was calculated for patients in each tumor size strata according to the year of operation using the Kaplan‐Meier method. The patient‐, tumor‐, and surgery‐related characteristics associated with PFS and overall survival (OS) were explored using univariate analysis, and all significant variables were retained in a multivariate Cox regression analysis. RESULTS. Overall, the number of nephrectomies increased for all tumor size categories from 1989 to 2004. A tumor size migration was evident during this period, because the proportion of patients with tumors 7 cm decreased. One hundred seventy‐nine patients (11%) developed disease progression after nephrectomy. Sixteen patients (1%) developed local recurrences, and 163 patients (10%) developed distant metastases. When 5‐year PFS was calculated for each tumor size strata according to 4‐year cohorts, trends in PFS did not improve or differ significantly over time. Compared with historic cohorts, patients in more contemporary cohorts were more likely to undergo partial nephrectomy rather than radical nephrectomy and were less likely to undergo concomitant lymph node dissection and adrenalectomy. Multivariate analysis demonstrated that pathologic stage and tumor grade were associated with disease progression, whereas patient age and tumor stage were associated with overall
ISSN:0008-543X
1097-0142
DOI:10.1002/cncr.23520