Overall Survival After Partial Versus Radical Nephrectomy For A Small Renal Mass: A Systematic Review And Meta-Analysis Of Observational Studies

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Evidence-based Medicine & Outcomes I1 Apr 2014PD2-11 OVERALL SURVIVAL AFTER PARTIAL VERSUS RADICAL NEPHRECTOMY FOR A SMALL RENAL MASS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF OBSERVATIONAL STUDIES Helen R. Levey, Emil Scosyrev, Kevin Wu, Vineet Agrawal, Edward Messing, and Guan Wu Helen R. LeveyHelen R. Levey More articles by this author , Emil ScosyrevEmil Scosyrev More articles by this author , Kevin WuKevin Wu More articles by this author , Vineet AgrawalVineet Agrawal More articles by this author , Edward MessingEdward Messing More articles by this author , and Guan WuGuan Wu More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.143AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In a meta-analysis of 20 observational studies published prior to Feb. 2011, partial nephrectomy (PN) was associated with improved overall survival (OS) compared with radical nephrectomy (RN). However, in the only randomized trial of PN vs. RN (EORTC 30904), OS was significantly better in the RN arm. This occurred despite much lower incidence of at least moderate renal dysfunction after PN with similar oncologic outcomes seen in the two intervention arms. We present an updated systematic review of observational studies of OS after PN vs. RN, and a meta-analysis performed on a subset of studies satisfying select quality criteria. METHODS Literature search was performed to Sept. 1, 2013. All studies comparing OS after PN vs. RN were eligible for the review. Additional eligibility criteria for the meta-analysis were (1)malignant tumors ≤7 cm or benign tumors of any size, and (2)survival analysis performed with adjustment for confounding variables. The pooled estimate of the hazard ratio (HR) was computed using the inverse variance weighting approach with random effects. Heterogeneity was assessed with Cochran’s Q test. RESULTS A total of 26 studies were eligible for the systematic review. Of these, 16 studies reported only the unadjusted survival analysis despite substantial differences between PN and RN pts in baseline characteristics, or imposed no upper bound on the tumor size, thus including a large number of locally advanced cases, mostly treated with RN. Because these studies had a strong selection bias in favor of PN pts which were younger with less advanced tumors, they were excluded from the meta-analysis. Meta-analysis of the remaining 10 studies is summarized in Table 1. The pooled HR indicated improved OS after PN, although there was substantial disagreement between individual studies in reported HRs with strong evidence of statistical heterogeneity (p=0.006). CONCLUSIONS A meta-analysis of 10 observational studies resulted in a pooled HR for OS favoring PN, but with substantial evidence of heterogeneity. Because residual confounding could be present in these observational studies despite adjustment for measured covariates, another randomized trial of PN vs. RN may be needed to definitively confirm or refute findings of EROTC 30904. Table 1. Meta-analysis of observational studies of OS after PN vs. RN for malignant tumors ≤7 cm or benign tumors of any size Study Size (cm) No. Subjects PN / RN F/U (yr) PN / RN HR 95% LCL 95% UCL Badalato 2011 4-7 1047 / 10209 2.8 / 3.4 1.10 0.91 1.36 Huang 2009 ≤4 556 / 2547 3.6 0.72 0.59 0.88 Kaushik 2013 Benign 236 / 206 8.3 0.57 0.35 0.93 Lau 2000 ≤7 130 / 126 3.4 / 4.0 0.96 0.52 1.74 Tan 2012 ≤4 1925 / 5213 5.2 0.54 0.34 0.85 Thompson 2008 ≤4 358 / 290 5.6 / 9.4 0.89 0.64 1.25 Thompson 2009 4-7 286 / 873 3.4 / 5.3 1.06 0.79 1.45 Weight 2010 Benign 388 / 111 4.2 0.40 0.19 0.91 Weight 2010 4-7 524 / 480 4.2 / 3.8 0.62 0.40 0.94 Zini 2009 ≤4 2198 / 7611 2.9 / 3.8 0.81 0.71 0.92 All 0.79 0.68 0.93 © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e18-e19 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Helen R. Levey More articles by this author Emil Scosyrev More articles by this author Kevin Wu More articles by this author Vineet Agrawal More articles by this author Edward Messing More articles by this author Guan Wu More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...