STOCKHOLM, SWEDEN (UroToday.com) - The aim of this retrospective, multi-institutional study from Germany (6 centers) was to shine more light on an ongoing debate of whether patients with clinical T1a renal masses benefit more from partial nephrectomy (PN) or radical nephrectomy (RN). The impact of surgery type on overall survival (OS) was the end point of this study. A total of 6 074 renal surgeries were performed (4 505 RN (70%) vs 1 440 PN). Median follow-up for the entire cohort was 54 months. They used Kaplan-Meier and Cox regression analyses in order to identify prognosticators for OS.
RN was most commonly carried out on those patients who presented with metastatic disease, poor RCC differentiation, and higher stages. Out of the PN cohort, “elective” (ePN) was performed in 1 132 (18.6%), and “imperative” partial nephrectomy (iPN) in 308 (5.1%) of the patients. When considering all patients, the calculated 10-year OS rates were 73.5% for ePN, 49.7% for iPN, and 52.3% for RN. After excluding patients with metastatic disease at the time of surgery, the 10-year OS rates were 74.1%, 54.0%, and 61.1% (p < 0.001). On multivariate analysis including age, sex, tumor size, histology, metastatic status, and the year of surgery, ePN remained as an independent factor for better improved OS compared to RN (HR 0.74, 95% CI 0.62-0.89, p=0.001).
Although this was a retrospective study and comorbidity index was not reported, similar to other previously published cohorts, PN was associated with improved OS during a period of approximately 4.5 years follow-up. A prospective randomized trial with > 10 years of follow-up is needed to draw a more solid conclusion on whether PN is superior to RN.
Presented by F. C. Roos, S. Steffens, K. Junker, K. Junker, M.Janssen, F. Becker, W. Brenner, M Schrader, R. Hofmann, J. W. Thüroff, M. A. Kuczyk, H. Wunderlich, S. Siemer, M. Stöckle, and A. J. Schrader at the 29th Annual European Association of Urology (EAU) Congress - April 11 - 15, 2014 - Stockholmsmässan - Stockholm, Sweden.
Johannes Gutenberg University, Dept. of Urology, Mainz, Germany, University Medical School, Dept. of Urology and Urological Oncology, Hanover, Germany, Saarland University Medical Center, Dept. of Urology, Homburg/Saar, Germany, Jena University Hospital, Dept. of Urology, Jena, Germany, University Medical Center, Dept. of Urology, Ulm, Germany, Philipps University of Marburg, Dept. of Urology, Marburg, Germany, University Medical School, Dept. of Urology and Urological Oncology, Mainz, Germany, Eisenach St. Georg Hospital, Dept. of Urology and Pediatric Urology, Eisenach, Germany
Written by Reza Mehrazin, MD, medical writer for UroToday.com