Other-Cause Mortality, According to Partial vs. Radical Nephrectomy: Age and Stage Analyses.

Area of Science:

• Urology
• Nephrology
• Oncology

Background:

• Renal cell carcinoma (RCC) is a common malignancy.
• Surgical management options include partial nephrectomy (PN) and radical nephrectomy (RN).
• The impact of surgical approach on non-cancer-specific mortality is an important consideration for patient outcomes.

Purpose of the Study:

• To compare other-cause mortality between partial nephrectomy and radical nephrectomy in patients with localized renal cell carcinoma (stages T1a, T1b, T2).
• To analyze these outcomes across different patient age groups.

Main Methods:

• Retrospective analysis of the Surveillance, Epidemiology, and End Results (SEER) database (2010-2020).
• Inclusion of patients with localized RCC (T1a-T2, N0, M0) and tumor size between 2-10 cm who underwent either PN or RN.
• Utilized cumulative incidence plots and multivariable competing risks regression models.

Main Results:

• Of 68,195 patients, 42% had PN and 58% had RN.
• In T1a RCC patients, 5-year other-cause mortality was 6% for PN vs. 11% for RN.
• PN independently predicted lower other-cause mortality in T1a patients across all ages (HR: 0.73, P < .001), including subgroups ≤59, 60-69, and ≥70 years.
• No significant other-cause mortality advantage for PN over RN was observed in T1b (8% vs. 10%) or T2 (8% vs. 9%) RCC patients.

Conclusions:

• Partial nephrectomy is associated with reduced other-cause mortality in T1a renal cell carcinoma patients across all age categories.
• Partial nephrectomy does not offer a clinically meaningful other-cause mortality benefit for T1b or T2 renal cell carcinoma, irrespective of patient age.