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Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response.  Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Aged, Carcinoma, Renal Cell, Cohort Studies, Female, Humans, Kidney Neoplasms, Male, Middle Aged, Nephrectomy, Regression Analysis, Retrospective Studies, Risk Factors, Survival Analysis, Treatment Outcome.
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Does nephrectomy improve the survival of patients with locally advanced renal cell carcinoma? Context: To examine the cancer-specific survival of patients treated with nephrectomy and compared it to that of patients managed without surgery. Of 43,143 patients with renal cell carcinoma (RCC) identified in the 1988-2004 Surveillance, Epidemiology and End Results database, 7068 had locally advanced RCC and with no distant metastasis. These patients had a nephrectomy (6786, 96.0%) or no surgical therapy (282, 4.0%). Multivariable Cox regression models, and matched and unmatched Kaplan-Meier survival analyses, were used to compare the effect of nephrectomy vs non-surgical therapy on cancer-specific survival. Also, competing-risks regression models adjusted for the effect of other-cause mortality. Covariates and matching variables consisted of age, gender, tumour size and year of diagnosis. The 1-, 2-, 5- and 10-year cancer-specific survival of patients who had nephrectomy was 88.9%, 88.1%, 68.6% and 57.5%, vs 44.8%, 30.6%, 14.5% and 10.6% for non-surgical therapy. In multivariable analyses, relative to nephrectomy, non-surgical therapy was associated with a 5.8-fold higher rate of cancer-specific mortality (P < 0.001). Non-surgical therapy was also associated with a 5.1-fold higher rate of cancer-specific mortality in matched analyses (P < 0.001). Finally, competing-risks regression confirmed the statistical significance of the variable defining treatment type (nephrectomy vs non-surgical therapy) in multivariable and matched analyses (P < 0.001).
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Relative to non-surgical treatment, nephrectomy improves the cancer-specific survival of patients with locally advanced RCC; our findings await prospective confirmation. Final Decision: yes