Articles

Platinum Priority – Kidney Cancer
Editorial by R. Houston Thompson on pp. 378–379 of this issue

Renal Function After Nephron-sparing Surgery Versus Radical Nephrectomy: Results from EORTC Randomized Trial 30904 eulogo1

By: Emil Scosyrev a, Edward M. Messing a lowast , Richard Sylvester b, Steven Campbell c and Hendrik Van Poppel d

European Urology, Volume 65 Issue 1, February 2014, Pages 372-377

Published online: 01 February 2014

Keywords: Kidney cancer, Nephron-sparing surgery, Radical nephrectomy

Abstract Full Text Full Text PDF (520 KB)

Abstract

Background

In the European Organization for Research and Treatment of Cancer (EORTC) randomized trial 30904, nephron-sparing surgery (NSS) was associated with reduced overall survival compared with radical nephrectomy (RN) over a median follow-up of 9.3 yr (hazard ratio: 1.50; 95% confidence interval [CI], 1.03–2.16).

Objective

To examine the impact of NSS relative to RN on kidney function in EORTC 30904.

Design, setting, and participants

This phase 3 international randomized trial was conducted in patients with a small (≤5cm) renal mass and normal contralateral kidney who were enrolled from March 1992 to January 2003.

Intervention

Patients were randomized to RN (n=273) or NSS (n=268).

Outcome measurements and statistical analysis

Follow-up estimated glomerular filtration rates (eGFR; milliliters per minute per 1.73 m2) were recorded for 259 subjects in the RN arm and 255 subjects in the NSS arm. Percentages of subjects developing at least moderate renal dysfunction (eGFR <60), advanced kidney disease (eGFR <30), or kidney failure (eGFR <15) were calculated for each treatment arm based on the lowest recorded follow-up eGFR (intent-to-treat analysis).

Results and limitations

With a median follow-up of 6.7 yr, eGFR <60 was reached by 85.7% with RN and 64.7% with NSS, with a difference of 21.0% (95% CI, 13.8–28.3); eGFR <30 was reached by 10.0% with RN and 6.3% with NSS, with a difference of 3.7% (95% CI, –1.0 to 8.5); and eGFR <15 was reached by 1.5% with RN and 1.6% with NSS, with a difference of –0.1% (95% CI, –2.2 to 2.1). Lack of longer follow-up for eGFR is a limitation of these analyses.

Conclusions

Compared with RN, NSS substantially reduced the incidence of at least moderate renal dysfunction (eGFR <60), although with available follow-up the incidence of advanced kidney disease (eGFR <30) was relatively similar in the two treatment arms, and the incidence of kidney failure (eGFR <15) was nearly identical. The beneficial impact of NSS on eGFR did not result in improved survival in this study population.

Registration

EORTC trial 30904; ClinicalTrials.gov identifier NCT00002473.

Take Home Message

Compared with radical nephrectomy, nephron-sparing surgery substantially reduced the incidence of moderate renal dysfunction but did not result in improved survival with available follow-up.

Keywords: Kidney cancer, Nephron-sparing surgery, Radical nephrectomy.

Footnotes

a Department of Urology, University of Rochester Medical Center, Rochester, NY, USA Department of Urology, University of Rochester Medical Center, Rochester, NY, USA

b Department of Biostatistics, EORTC Headquarters, Brussels, Belgium Department of Biostatistics, EORTC Headquarters, Brussels, Belgium

c Department of Urology, Cleveland Clinic, Cleveland, OH, USA Department of Urology, Cleveland Clinic, Cleveland, OH, USA

d Department of Urology, University Hospital K.U. Leuven, Leuven, Belgium Department of Urology, University Hospital K.U. Leuven, Leuven, Belgium

lowast Corresponding author. Department of Urology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 656, Rochester, NY 14642. Tel. +1 585 275 1321; Fax: +1 585 273 1068.

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