Renal function after nephron-sparing surgery versus radical nephrectomy: results from EORTC randomized trial 30904

Area of Science:

• Nephrology
• Urology
• Oncology

Background:

• European Organization for Research and Treatment of Cancer (EORTC) trial 30904 previously showed reduced survival with nephron-sparing surgery (NSS) versus radical nephrectomy (RN).
• NSS is a kidney-sparing alternative to RN for small renal masses.

Purpose of the Study:

• To evaluate the long-term impact of NSS versus RN on kidney function in EORTC trial 30904.
• To compare rates of renal dysfunction and failure between NSS and RN treatment arms.

Main Methods:

• Phase 3 international randomized trial involving patients with small renal masses (≤5 cm) and normal contralateral kidney.
• Patients were randomized to either RN (n=273) or NSS (n=268).
• Estimated glomerular filtration rates (eGFR) were monitored to assess renal dysfunction (eGFR <60), advanced kidney disease (eGFR <30), and kidney failure (eGFR <15).

Main Results:

• NSS significantly reduced the incidence of at least moderate renal dysfunction (eGFR <60) compared to RN (64.7% vs. 85.7%).
• The incidence of advanced kidney disease (eGFR <30) was similar between groups (6.3% with NSS vs. 10.0% with RN).
• Kidney failure (eGFR <15) rates were nearly identical between NSS and RN arms (1.6% vs. 1.5%).

Conclusions:

• NSS substantially preserves kidney function, significantly lowering the risk of moderate renal dysfunction compared to RN.
• While NSS benefits kidney function, it did not translate to improved overall survival in this study population.
• Longer follow-up is needed to fully ascertain the long-term renal outcomes and survival impact of NSS versus RN.