Real-World Survival Outcomes of Partial Versus Radical Nephrectomy: Cause-Specific and Time-Dependent Effects

Area of Science:

• Urology
• Oncology
• Nephrology

Background:

• Localized renal cell carcinoma (RCC) treatment involves either radical nephrectomy (RN) or partial nephrectomy (PN).
• The long-term survival outcomes and mortality causes following these procedures require further investigation, particularly in real-world settings.

Purpose of the Study:

• To compare the prognosis of radical nephrectomy (RN) and partial nephrectomy (PN) in patients with localized renal cell carcinoma (RCC).
• To specifically assess cause-specific mortality (CSM) and other-cause mortality (OCM) and their time-dependent effects on survival outcomes.

Main Methods:

• A multicenter, retrospective study involving 802 patients with localized RCC, with 401 patients in each of the RN and PN groups.
• Propensity score matching was used to minimize bias between the nonrandomized groups.
• Conditional survival (CS) analysis was employed to evaluate overall survival (OS), CSM, and OCM.

Main Results:

• Patients undergoing RN had significantly poorer OS compared to those undergoing PN (P = .031).
• CS analysis showed consistently higher CS rates in the PN group than the RN group throughout the follow-up period.
• The RN group exhibited a consistently high rate of OCM, while OCM and CSM remained low in the PN group and for CSM in the RN group.

Conclusions:

• Partial nephrectomy (PN) is associated with superior overall survival (OS) compared to radical nephrectomy (RN) for localized renal cell carcinoma (RCC).
• The improved survival with PN is primarily attributed to a lower incidence of other-cause mortality (OCM) during the follow-up period.