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Comparison of outcomes of radical and partial nephrectomy for sarcomatoid renal cell carcinoma: analysis of the national cancer database.
Wang, Luke L; Yuen, Kit L; Saitta, Cesare; Meagher, Margaret F; Liu, Franklin; Guer, Melis; Puri, Dhruv; Chen, Yu-Wei; Javier-Desloges, Juan; McKay, Rana R; Derweesh, Ithaar H.
Afiliación
  • Wang LL; Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA.
  • Yuen KL; Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA.
  • Saitta C; Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA.
  • Meagher MF; Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA.
  • Liu F; Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA.
  • Guer M; Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA.
  • Puri D; Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA.
  • Chen YW; Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA.
  • Javier-Desloges J; Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA.
  • McKay RR; Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA.
  • Derweesh IH; Moores UCSD Cancer Center, UC San Diego School of Medicine, 3855 Health Science Drive, La Jolla, CA, 92037, USA.
World J Urol ; 42(1): 508, 2024 Sep 06.
Article en En | MEDLINE | ID: mdl-39240329
ABSTRACT

PURPOSE:

To compare outcomes of radical (RN) and partial nephrectomy (PN) in Sarcomatoid Renal Cell Carcinoma (sRCC) utilizing a large national cohort. As RN is the reference standard for localized RCC with clinically aggressive features, PN in sRCC has been seldom studied.

METHODS:

We performed a retrospective cohort analysis of the National Cancer Database from 2004 to 2019 for patients who underwent PN and RN for sRCC (T1-T3N0-N1M0). We performed multivariable analyses (MVA) to determine factors associated with PN and all-cause mortality (ACM), and Kaplan-Meier Analysis (KMA) for overall survival (OS) in Charlson 0 patients who underwent PN vs. RN according to clinical stage.

RESULTS:

The cohort consisted of 5,265 patients [RN 4,582 (87.0%)/PN 683 (13.0%)]. Increased odds of receiving PN was associated with papillary RCC (OR = 1.69, p = 0.015); inversely with increasing age (OR = 0.99, p = 0.004), cT2-cT3 (OR = 0.23, p < 0.001), and cN1 (OR = 0.2, p < 0.001). Worsened ACM was associated with positive margins (HR = 1.59, p < 0.001), male (HR = 1.1, p = 0.044), Charlson [Formula see text]2 (HR = 1.47, p < 0.001), cT2-cT3 (HR 1.17-1.39, p < 0.001-0.035), and cN1 (HR = 1.59, p < 0.001). Improved ACM was noted with PN (HR = 0.64, p < 0.001), increasing household income (HR = 0.77-0.79, p < 0.001), and private insurance (HR = 0.80, p = 0.018). KMA showed PN had improved 5-year OS compared to RN in cT1 (86.5% vs. 63.2%, p < 0.001), and cT3 (61.0% vs. 44.0% p < 0.001), but not cT2 (p = 0.67).

CONCLUSION:

In select patients, PN with negative margins may not compromise outcomes and may provide benefit when indicated. Patients with private insurance and highest income experienced improved survival suggesting disparity in care.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Carcinoma de Células Renales / Bases de Datos Factuales / Neoplasias Renales / Nefrectomía Límite: Aged / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: World J Urol Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Alemania
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Carcinoma de Células Renales / Bases de Datos Factuales / Neoplasias Renales / Nefrectomía Límite: Aged / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: World J Urol Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Alemania