Kidney cancer patients who had only their
tumor removed had better survival than patients who had their entire kidney
removed, according to a new study from researchers at the University of
Michigan Comprehensive Cancer Center.
After
an average of five years, 25 percent of patients who had a so-called partial
nephrectomy, in which only the tumor and a small margin of healthy tissue is
removed, had died, while 42 percent of patients who had radical nephrectomy,
in which the entire kidney is removed, had died, the study found. Results
appear in the April 18 Journal
of the American Medical Association.
"For
patients who are candidates for partial nephrectomy, it should be the preferred
treatment option. We found that patients who were younger or had pre-existing
medical conditions benefited most from partial nephrectomy," said lead
study author Hung-Jui Tan, M.D., a urology resident at the U-M Medical School.
The
researchers looked at 7,138 Medicare
beneficiaries with early stage kidney cancer up to eight years after
treatment. Patients were equally likely to die of kidney cancer, regardless of
the type of surgery they received, suggesting that each procedure was equally
likely to cure the cancer. The survival discrepancy was found in the number of
patients who died from any cause.
The study
showed that if only seven patients chose partial nephrectomy over radical
nephrectomy, it would save one extra life.
Early
stage kidney cancers have become more common recently. These are often
discovered by chance when patients receive an X-ray or CT scan for something
unrelated.
"As
more and more people are identified with these small, early stage cancers,
there's more interest in understanding how best to treat these patients,"
says senior study author David C. Miller, M.D., M.P.H., assistant professor of
urology at the U-M Medical School and member of U-M's Institute for Health Care
Policy and Innovation.
The
question, though, is whether partial nephrectomy – which is a more technically
challenging procedure and potentially associated with more short-term
complications – is preferable to radical nephrectomy.
Removing
a kidney can increase the risk of chronic kidney disease, which is associated
with lipid disorders, cardiovascular disease and renal failure.
The
debate is similar to breast cancer surgery, in which studies have found that
lumpectomy plus radiation is comparable to mastectomy. While that choice often
comes down to a cosmetic trade-off, the trade-off with kidney cancer is a
potential higher risk of short-term complications with partial nephrectomy vs.
avoiding chronic kidney disease in the long term.
"This
study does not suggest every patient with early stage kidney cancer should
get a partial nephrectomy. It supports the notion that we need to expand the
use of partial nephrectomy and make it a preferred treatment choice for patients with small
tumors as much as possible, to optimize long term survival," Miller says.
More
information: Journal
of the American Medical Association, Vol. 307, No. 15, April 18, 2012
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