Partial nephrectomy may be an acceptable alternative to radical nephrectomy for selected patients with high-risk renal cell carcinoma (RCC) and large renal masses, according to data presented during the American Urological Association 2020 Virtual Experience.
In a study of 970 patients with pT3a RCC and no metastases, a team led by E. Jason Abel, MD, of the University of Wisconsin in Madison, and colleagues demonstrated that PN is not independently associated with an increased likelihood of cancer recurrence in patients with high-risk RCC.
Of the 970 patients, 110 (11%) and 860 (89%) underwent PN and RN, respectively. Patients had a mean age of 64 years and a mean tumor diameter of 7.5 cm. Clear cell RCC was the most common histologic subtype. The median overall follow-up was 20.5 months.
“Although only 11% of patients were considered acceptable to be treated with partial nephrectomy, these data suggest that well-selected patients may have equivalent outcomes with partial nephrectomy even in high-risk cohorts,” Dr Abel told Renal & Urology News.
The inclusion of only the highest-risk patients from 4 high-volume centers is a distinguishing feature of the study, said Dr Abel, Associate Professor of Urologic Surgery.
Dr Abel and his collaborators identified recurrent disease in 256 patients (26.4%) at a median of 8.3 months following attempted curative surgery. On multivariable analysis, tumor diameter, nuclear grade, tumor thrombus, and systemic symptoms were independently associated with RCC recurrence risk. Recurrence risk did not differ between PN and RN.
In a study of 446 patients with clinical T2 renal masses—a group that consisted of 73 PN patients propensity score matched to 373 RN patients— Matvey Tsivian, MD, and colleagues at Mayo Clinic in Rochester, Minnesota, reported finding that complication rates were similar for the PN and RN patients (19% vs 13%, respectively). Severe complications were more common in the PN group (4% vs 2%), but the difference was not statistically significant.
The decline in estimated glomerular filtration rate (eGFR) at 1 and 3 years was more pronounced in the RN than PN group (16 vs 5 and 13 vs 2 mL/min/1.73 m2, respectively).
A greater proportion of RN patients had new-onset eGFR below 60 at 1 and 3 years (55% vs 17% and 48% vs 17%, respectively). Clinical and radiographic features were well balanced between the groups, the investigators noted.
In a subset of patients with RCC, overall, cancer-specific, and metastasis-free survival rates were similar, according to Dr Tsivian’s team.
Davidson EL, Raman JD, Master VA, et al. Partial nephrectomy is not associated with recurrence in selected high risk renal cell carcinoma patients. Presented at the American Urological Association 2020 Virtual Experience held in May. Abstract PD11-08.
Tsivian M, Packiam V, Lohse C, et al. Partial versus radical nephrectomy in clinical T2 renal masses. Presented at the American Urological Association 2020 Virtual Experience held in May. Abstract PD449-12.