Radical, Partial Nephrectomy Do Not Differ in Survival Outcomes

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Propensity score-matched analysis shows that radical and partial nephrectomy for cT1 renal cell carcinoma are associated with similar cancer-specific and all-cause mortality, a study found.
Propensity score-matched analysis shows that radical and partial nephrectomy for cT1 renal cell carcinoma are associated with similar cancer-specific and all-cause mortality, a study found.

Radical and partial nephrectomy for small renal cell carcinoma (RCC) tumors are associated with similar cancer-specific and all-cause mortality, according to investigators.

Radical nephrectomy (RN), however, is associated with a higher risk of chronic kidney disease (CKD) compared with partial nephrectomy (PN).

In their propensity-score (PS) based analysis of 1609 patients with cT1 RCC (of whom 919 and 690 underwent PN and RN, respectively), Boris Gershman, MD, of the Warren Alpert Medical School of Brown University in Providence, Rhode Island, and colleagues at Mayo Clinic in Rochester, Minnesota found no statistically significant associations between nephrectomy type and distant metastases, cancer-specific, or all-cause mortality, after adjusting for preoperative and pathologic features.

In a subset of 363 matched pairs of RN and PN patients, RN was associated with a significant 73% decreased risk of local ipsilateral recurrence of disease compared with PN, but a significant 2-fold increased risk of a 10% decrease in estimated glomerular filtration rate (eGFR) and 2.7-fold increased risk of a decrease in eGFR to below 45 mL/min/1.73 m2, Dr Gershman's team reported online ahead of print in European Urology.

The 1609 patients with cT1 RCC in the PS analytic cohort were a subset of an overall cohort of 2459 patients with a cT1 solid renal mass treated with RN (39%) or PN (61%). In the overall cohort, the RN group was older than the PN group (mean 66 vs 61 years) and had more advanced tumors and more adverse tumor features. The RN group also had a greater comorbidity burden and worse Eastern Cooperative Oncology Group performance status.

“Our findings reinforce prior observations that patients who undergo RN have more aggressive tumor characteristics and more advanced disease,” the authors wrote. “The inability to properly adjust for these confounding variables may result in the paradoxical association of inferior oncologic outcomes with more radical surgery.”

Reference

Gershman B, Thompson RH, Boorjian SA, et al. Radical versus partial nephrectomy for cT1 renal cell carcinoma. Eur Urol. 2018; published online ahead of print.

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