Radical Versus Partial Nephrectomy for cT1 Renal Cell Carcinoma

Area of Science:

• Urology
• Nephrology
• Oncology

Background:

• Nephron-sparing surgery is preferred for cT1 renal masses, but survival benefit data between partial nephrectomy (PN) and radical nephrectomy (RN) are conflicting.
• Existing research presents conflicting observational and randomized data regarding the survival advantage of PN over RN.

Purpose of the Study:

• To compare oncologic and nononcologic outcomes between radical nephrectomy (RN) and partial nephrectomy (PN).

Main Methods:

• A retrospective analysis of 2459 adult patients treated with RN or PN for unilateral, sporadic, cT1, M0 solid renal masses between 1990 and 2011.
• Propensity score (PS) techniques were used to adjust for preoperative and pathologic features, evaluating outcomes including recurrence, metastasis, cancer-specific mortality (CSM), other-cause mortality (OCM), and chronic kidney disease (CKD).

Main Results:

• After PS adjustment, RN was associated with increased risks of distant metastases, CSM, CKD10%, and CKD<45 compared to PN.
• In a subset of 1609 patients with renal cell carcinoma (RCC), after adjusting for preoperative and pathologic features, no significant difference in distant metastases or CSM was observed between RN and PN.
• RN remained associated with significantly higher risks of CKD10% and CKD<45, but not OCM or ACM.

Conclusions:

• Radical nephrectomy (RN) is associated with an increased risk of chronic kidney disease compared to partial nephrectomy (PN).
• However, RN was not associated with a statistically significant difference in cancer-specific mortality or all-cause mortality among patients with cT1 renal cell carcinoma.
• Partial nephrectomy (PN) does not appear to offer a markedly improved survival benefit compared to radical nephrectomy (RN).