Partial nephrectomy (PN) is the optimal surgical approach for T1a renal cell carcinoma (RCC), investigators who conducted a population-based study reported at the Canadian Urological Association 74th annual meeting in Quebec City.
Of 5670 patients with T1a RCC undergoing surgery in Ontario during the years 1995 to 2014, 2503 (44%) had PN and 3167 (56%) had radical nephrectomy (RN). During a median follow-up period of 6.4 years, 1187 patients died.
Compared with RN, PN was associated with significant 27% and 56% decreased risks of overall and cancer-specific mortality, respectively, according to multivariate Cox proportional hazard models, Madhur Nayan, MDCM, of the University of Toronto, and colleagues reported. In addition, PN patients had a significant 82% lower risk of chronic kidney disease compared with RN patients. End-stage renal disease developed in 15 patients, but the investigators found no significant association with type of surgery.
Patients in the PN group were more likely to be male, younger, have lower Charlson comorbidity scores, smaller tumors, and more recent surgery than RN patients, Dr Nayan’s team reported.
The National Comprehensive Cancer Network currently recommends PN for T1a RCC as primary treatment, with RN reserved for unsuitable cases or centrally located tumors. “Nephron-sparing surgery has been used increasingly in patients with T1a and T1b renal tumors (ie, up to 7 cm in greatest dimension) and a normal contralateral kidney, with equivalent outcomes to radical nephrectomy,” according to the guideline authors. “Radical nephrectomy should not be employed when nephron sparing can be achieved.”
Nayan M, Saarela O, Lawson K, et al. Long-term outcomes after radical or partial nephrectomy for T1a kidney cancer: a population-based study. Presented at the 2019 Canadian Urological Association 74th annual meeting held June 29-July 1 in Quebec City. Abstract MP-9.8.
NCCN Guidelines Version 4.2018 Kidney Cancer. Accessed on June 24, 2019 at https://www2.tri-kobe.org/nccn/guideline/urological/english/kidney.pdf