Recurrence after radical and partial nephrectomy in high complex renal tumor using propensity score matched analysis

Area of Science:

• Urology
• Nephrology
• Oncology

Background:

• Radical nephrectomy (RN) and partial nephrectomy (PN) are surgical options for kidney tumors.
• The RENAL nephrometry score helps classify tumor complexity.
• Evaluating outcomes for complex tumors (RENAL score ≥10) is crucial for treatment decisions.

Purpose of the Study:

• To compare recurrence and survival rates between RN and PN for patients with high RENAL score kidney tumors.
• To assess the impact of surgical approach on renal function preservation.
• To identify predictors of recurrence and mortality in this patient cohort.

Main Methods:

• Retrospective analysis of 474 patients (236 RN, 238 PN) with RENAL score ≥10.
• Propensity score-matched analysis to compare functional outcomes, recurrence patterns, and survival rates (RFS, CSS, OS).
• Cox-regression analysis to determine predictors of recurrence and death.

Main Results:

• PN preserved renal function significantly better than RN (p < 0.001).
• Five-year survival rates (RFS, CSS, OS) were comparable between PN and RN groups.
• Pathologic T stage predicted recurrence (HR 3.99, p=0.036), and the R domain of RENAL score predicted death (HR 3.80, p=0.046).

Conclusions:

• Partial nephrectomy is a viable option for preserving renal function in patients with complex kidney tumors (RENAL score ≥10).
• Survival outcomes after PN are comparable to RN in this challenging group.
• Careful patient selection and surgical technique are essential for PN due to potential recurrence and survival implications.