Preserving Renal Function through Partial Nephrectomy Depends on Tumor Complexity in T1b Renal Tumors

Area of Science:

• Urology
• Nephrology
• Oncology

Background:

• T1b renal cell carcinoma (RCC) presents a clinical challenge regarding optimal surgical management.
• Partial nephrectomy (PN) and radical nephrectomy (RN) are surgical options, with varying impacts on renal function.
• Preoperative identification of patients who would benefit most from PN is crucial for preserving kidney function.

Purpose of the Study:

• To determine which T1b RCC patients benefit from PN.
• To identify a preoperative method for selecting suitable candidates for PN.
• To evaluate the role of nephrometry score (NS) in predicting postoperative chronic kidney disease (CKD) risk.

Main Methods:

• Retrospective analysis of 120 patients with T1b RCC treated with RN or PN between 1995 and 2010.
• Propensity-score matching (1:2) was used to balance patient characteristics between surgical groups.
• Kaplan-Meier analysis and Cox regression were employed to assess the probability of CKD postoperatively, considering NS and surgical method.

Main Results:

• Overall 5-year CKD probability was significantly lower after PN (13.5%) compared to RN (40.7%).
• PN was associated with reduced CKD risk irrespective of age, comorbidity, or preoperative renal function, but only for patients with NS ≤ 8.
• For T1b RCC patients with NS ≥ 9, PN did not reduce the risk of postoperative CKD compared to RN.

Conclusions:

• Partial nephrectomy offers significant renal function preservation for T1b RCC patients with NS ≤ 8.
• For T1b RCC with NS ≥ 9, the benefits of PN in terms of CKD risk reduction are not evident compared to RN.
• Minimally invasive radical nephrectomy should be prioritized for T1b RCC patients with NS ≥ 9, considering potential PN complications.