Partial Nephrectomy is Associated with Higher Risk of Relapse Compared with Radical Nephrectomy for Clinical Stage T1 Renal Cell Carcinoma Pathologically Up Staged to T3a

Abstract Background Despite randomized data demonstrating better overall survival favoring radical nephrectomy, partial nephrectomy continues to be the treatment of choice for low-stage renal cell carcinoma. Methods We utilized the National Cancer Database to identify patients younger than 50 years diagnosed with low-stage renal cell carcinoma (cT1) treated with radical nephrectomy or partial nephrectomy (2004–2007). Inverse probability of treatment weighting adjustment was performed for all preoperative factors to account for confounding factors. Kaplan-Meier curves and Cox proportional hazards regression analyses were used to compare overall survival of patients in the two treatment arms. Sensitivity analysis was performed to explore the interaction of type of surgery and clinical stage on overall survival. Results Among the 3009 patients (median age = 44 years [interquartile range (IQR) = 40–47 years]), 2454 patients (81.6%) were treated with radical nephrectomy and 555 patients (18.4%) with partial nephrectomy. The median follow-up was 108.6 months (IQR = 80.2–124.3 months) during which 297 patients (12.1%) in the radical nephrectomy arm and 58 patients (10.5%) in the partial nephrectomy arm died. Following inverse probability of treatment weighting adjustment, there was no difference in overall survival between patients treated with partial nephrectomy and radical nephrectomy (hazard ratio = 0.83, 95% confidence interval = 0.63 to 1.10, P = .196). There were no statistically significant interactions between type of surgery and clinical stage on treatment outcome. Conclusions There was no difference in long-term overall survival between radical and partial nephrectomy in young and healthy patients. This patient cohort may have sufficient renal reserve over their lifetime, and preserving nephrons by partial nephrectomy may be unnecessary.

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PD66-08 PARTIAL NEPHRECTOMY IS ASSOCIATED WITH INCREASED RECURRENCE RISK AMONG CLINICAL STAGE T1 UPSTAGED TO PATHOLOGIC T3A RENAL CELL CARCINOMA

The Journal of Urology ◽

10.1016/j.juro.2017.02.2971 ◽

2017 ◽

Vol 197 (4S) ◽

Author(s):

Paras Shah ◽

Daniel Moreira ◽

Vinay Patel ◽

Arvin George ◽

Geoffrey Gaunay ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Partial Nephrectomy ◽

Renal Cell ◽

Clinical Stage ◽

Recurrence Risk ◽

Stage T1

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Radical versus partial nephrectomy and survival from stage T1 renal cell carcinoma in three prospective cohorts

10.1101/2021.10.17.21265105 ◽

2021 ◽

Author(s):

Christopher Martin Sauer ◽

Sarah C Markt ◽

Lorelei A Mucci ◽

Alejandro Sanchez ◽

Steven L Chang ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Overall Survival ◽

Cell Carcinoma ◽

Partial Nephrectomy ◽

Renal Cell ◽

Radical Nephrectomy ◽

Smoking History ◽

Significant Difference ◽

History Of ◽

Stage T1

Background: Whether or not a survival difference exists between radical and partial nephrectomy for stage T1 renal cell carcinoma (RCC) is controversial. We therefore aimed to evaluate cancer-specific, other cause, and overall survival among patients undergoing radical or partial nephrectomy for stage pT1 RCC. Materials and methods: We identified 330 participants with pT1a-b RCC diagnosed between 2000-2015 in three prospective cohort studies and compared treatment with radical nephrectomy (N=196) versus partial nephrectomy (N=134). The primary outcome was overall survival. Secondary outcomes were other-cause and cancer-specific mortality. Kaplan-Meier plots were used to visualize overall survival for the two treatment groups. Cox proportional hazards regression was utilized to compare outcomes between groups, and Fine and Gray competing risks regression was used to compare cancer-specific and other cause mortality between groups. Multivariable models adjusted for age, tumor size, sex, year of diagnosis, body mass index, history of smoking, history of hypertension, surgical technique, and pathological differentiation. Results: During a median follow-up of eight years, overall survival was 84%. We did not detect a statistically significant difference in overall survival between partial and radical nephrectomy (Hazard Ratio (HR) = 0.84, 95% Confidence Interval: 0.40-1.78). There was no significant difference in cause-specific or other cause mortality between groups. This study had 80% power to detect an HR ≥2.20. Conclusions: These results did not suggest a difference in long-term survival outcomes between radical and partial nephrectomy.

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