Partial Nephrectomy for Small Renal Tumors Offers Survival Edge

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Partial vs radical nephrectomy is associated with an overall survival advantage among patients with RCC tumors 4 cm or smaller and many patients with larger tumors.
Partial vs radical nephrectomy is associated with an overall survival advantage among patients with RCC tumors 4 cm or smaller and many patients with larger tumors.

Partial nephrectomy for renal cell carcinoma (RCC) tumors 4 cm or smaller is associated with improved overall survival (OS) compared with radical nephrectomy, but it is not associated with an OS advantage among patients aged 75 years or older with tumors larger than 4 cm, according to a new study.

In a study of 212,016 patients who underwent either radical nephrectomy (RN, 59.7%) or partial nephrectomy (PN, 40.3%), the 5-year adjusted OS rate for patients with tumors 4 cm or smaller (T1a tumors) was significantly higher for partial nephrectomy (PN) than radical nephrectomy (RN): 89.6% vs 85.1%. Survival differences were diminished among patients with tumors larger than 4 cm (T1b/T2 tumors), but the 5-year adjusted OS rate remained significantly higher for PN than RN: 82.5% vs 80.8%.

Compared with RN, PN was associated with a significant 27% and 12% decreased risk of death among patients with T1a and T1b RCC, respectively, in propensity score-adjusted models, Benjamin T. Ristau, MD, MHA, and colleagues at Fox Chase Cancer Center in Philadelphia reported online ahead of print in Cancer.

Among patients aged 75 years or older who had T1b/T2 tumors, PN was associated with a non-significant 11% decreased risk of death compared with RN. The investigators stated that the “tempered OS benefit for PN in older patients may occur because the accrued benefits of NSS [nephron-sparing surgery] are outweighed by other competing risks to mortality.”

“The choice of surgical approach in patients with larger tumors should be driven by a thorough discussion of individualized risks and benefits,” Dr Ristau's team concluded.

The investigators used the National Cancer Database to identify the study population, which had mean age of 60.4 years. From 2004 to 2014, the use of PN increased from 40.6% to 71.4% among patients with T1a tumors and from 8.4% to 26.5% among those with T1b/T2 tumors.

Reference

Ristau BT, Handorf EA, Cahn DB, et al. Partial nephrectomy is not associated with an overall survival advantage over radical nephrectomy in elderly patients with stage Ib-II renal masses: An analysis of the National Cancer Database. Cancer. 2018; published online ahead of print.

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