The benefit of partial nephrectomy (PN) compared to radical nephrectomy (RN) for T1a renal cell carcinoma (RCC) remains uncertain, with observational studies conflicting with level 1 evidence. Therefore, the purpose of this population-based study was to compare long-term outcomes in patients undergoing PN or RN for T1a RCC.
We studied 5670 patients in Ontario, Canada undergoing PN or RN for T1a RCC. The primary outcome was overall survival (OS). Secondary outcomes were cancer-specific survival (CSS), chronic kidney disease (CKD), end-stage renal disease (ESRD), and myocardial infarction (MI). We used multivariable Cox proportional hazard models to evaluate the association between PN or RN and these outcomes. A sensitivity analysis was performed in patients with a preoperative serum creatinine available.
Median followup was 77 months. Compared to RN, PN was associated with significantly improved OS (hazard ratio [HR] 0.73; 95% confidence interval [CI] 0.63-0.84), reduced risk of CKD (HR 0.18; 95% CI 0.12-0.27) and improved CSS (HR 0.45; 95% CI 0.30-0.65). The risk of myocardial infarction was not significantly different between groups (HR 0.91; 95% CI 0.62-1.34). Few patients (n=15) required renal replacement therapy. In the sensitivity analysis, the association between type of surgery and OS and CKD persisted, while the association with CSS did not.
Our study found that in patients undergoing surgery for T1a RCC, PN was associated with improved OS and reduced risk of CKD compared to RN. However, few patients in either group developed ESRD requiring renal replacement therapy.
Canadian Urological Association journal = Journal de l'Association des urologues du Canada. 2020 Jun 16 [Epub ahead of print]
Madhur Nayan, Olli Saarela, Keith Lawson, Lisa Martin, Maria Komisarenko, Antonio Finelli
Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada., Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.