Propensity Score-Matched Analysis of Radical and Partial Nephrectomy in pT3aN0M0 Renal Cell Carcinoma

We sought to evaluate oncological and functional outcomes of patients treated with partial nephrectomy (PN) and radical nephrectomy (RN) in pT3aN0M0 renal cell carcinoma (RCC).

We conducted a retrospective analysis of surgically treated pT3aN0M0 RCC patients. Primary outcome was all-cause mortality/overall survival (ACM/OS). Secondary outcomes were cancer-specific mortality/ cancer-specific survival (CSM/CSS), recurrence/progression free survival (PFS) and new onset de novo eGFR < 45 mL/min/1.73 m² (CKD-S3b). A propensity score matched model in a 1:1 ratio was conducted, within a caliper width of 0.01. Kaplan-Meier analysis (KMA) and Cox multivariable analysis (MVA) were fitted to delineate survival outcomes and their predictors.

After PSM 359 were analyzed (PN = 179 vs. RN = 180); median follow up of 38.7 (IQR 16.28-64) months. MVA for ACM revealed, high grade (HR 2.05, P = .019), and CKD-S3b at last follow up (HR 2.13, P = .018) as independent risk factors, while RN versus PN (P = .41) was not. MVA for CSM and recurrence revealed that RN versus PN was not an independent risk factor for CSM (P = .088) and recurrence (P = .277). MVA for CKD-S3b revealed RN versus PN (HR 1.67 P = .025) as associated with increased risk of CKD-S3b. KMA comparing PN versus RN revealed 5-year OS of 87.4% versus 82% (P = .26); 5-year CSS of 95.6% versus 90.3% (P = .15); 5-year PFS of 83.5% versus 77% (P = .38); 5-year CKD-S3b free survival of 80.8% versus 65.5% (P = .016).

PN exhibited oncological equipoise while reducing risk of development of eGFR < 45 mL/min/1.73 m². PN may be considered in T3a RCC when prioritization of functional preservation is indicated.