For patients with T1b renal cell carcinoma (RCC), partial nephrectomy provides long-term overall survival similar to that of radical nephrectomy, but with worse cancer-specific survival (CSS).
This the first meta-analysis of long-term oncologic outcomes between the surgical approaches, Yu-Li Jiang, MD, of The Affiliated Hospital of Hang Zhou Normal University in China, and colleagues reported in BMC Urology.
In their meta-analysis of 16 studies including 33,117 RCC patients with 4 to 7 cm tumors, no significant differences were found in 5- and 10-year overall survival (OS) or 5- and 10-year recurrence-free survival (RFS). However, radical nephrectomy (RN) slightly outperformed partial nephrectomy (PN) in CSS at 5 and 10 years. Results from previous studies have been conflicting, with some showing better CSS with PN.
Consistent with previous reports, PN preserved renal function better than RN. In 4 of the included studies, estimated glomerular filtration rate (eGFR) declined more (weighted mean difference −9.15) in the RN group.
PN and RN patients had comparable complication rates, the team found. Yet, they noted that tumor histology could affect outcomes.
“Our meta-analysis showed that PN may provide comparable outcomes in terms of RFS and OS, and better renal function preservation,” Dr Jiang and the team concluded. The evidence received a GRADE of moderate.
In an acknowledgement of study limitations, the authors noted that they did not include randomized controlled trials in the meta-analysis. The meta-analysis also was limited by potential selection bias because surgeons decided between PN and RN based on personal preference.
Jiang YL, Peng CX, Wang HZ, Qian LJ. Comparison of the long-term follow-up and perioperative outcomes of partial nephrectomy and radical nephrectomy for 4 cm to 7 cm renal cell carcinoma: a systematic review and meta-analysis. BMC Urol. 19:48. doi:10.1186/s12894-019-0480-6