Partial nephrectomy for T3aN0M0 renal cell carcinoma: shall we step forward?

Area of Science:

• Urology
• Nephrology
• Oncology

Background:

• Non-metastatic T3a renal cell carcinoma (RCC) presents a clinical challenge regarding optimal surgical management.
• Evaluating the long-term prognosis of partial nephrectomy (PN) versus radical nephrectomy (RN) is crucial for patient outcomes.

Purpose of the Study:

• To compare the oncological and renal function outcomes of partial nephrectomy (PN) versus radical nephrectomy (RN) in patients with non-metastatic T3a RCC.

Main Methods:

• Retrospective analysis of 125 patients with non-metastatic T3a RCC.
• Strict matching of patients undergoing PN and RN based on clinic-pathologic characteristics.
• Log-rank test and Cox regression models for univariate and multivariate survival analyses.

Main Results:

• 18 matched pairs were analyzed with a median follow-up of 35.5 months.
• Partial nephrectomy (PN) patients demonstrated significantly higher postoperative estimated glomerular filtration rate (eGFR).
• Cancer-specific survival (CSS) and recurrence-free survival (RFS) showed no significant difference between PN and RN groups.
• Multivariate analysis identified positive surgical margin and anemia as negative predictors for CSS and RFS.

Conclusions:

• Partial nephrectomy (PN) is a potential surgical option for non-metastatic pT3a RCC, offering comparable oncological results to radical nephrectomy (RN).
• PN is associated with superior renal function preservation post-surgery.
• Positive surgical margins and anemia are critical factors impacting survival outcomes in T3a RCC patients.