AUA 2018: Radical Versus Partial Nephrectomy for cT1 Renal Cell Carcinoma: A Propensity-Score Based Analysis

San Francisco, CA USA ( Previous observational studies suggest reduced chronic kidney disease risk as well as all-cause mortality in using partial nephrectomy (PN) with respect to radical nephrectomy (RN). However, the only randomized trial comparing PN and RN reported no significant benefit to PN.

Boris Gershman, MD and his colleagues examined the oncologic and non-oncologic outcomes of 2,024 patients using several propensity score techniques (adjusted for PS quintile, stratified by PS quintile, re-weighted by stabilized IPWs, and subset of 363 matched pairs). 849 patients received RN and 1,175 received PN between 1990 and 2011 for cT1 m0 pathologically-confirmed renal cell carcinoma (RCC). 1,609 patients were included in the PS study. Based on pathological features, cox regression models were further adjusted.

The oncologic outcomes observed were local ipsilateral recurrence, distance metastases, and cancer-specific mortality (CSM); non-oncologic outcomes were other-cause mortality (OCM), all-cause mortality (ACM), ≥10% decrease in estimated glomerular filtration rate (CKD10%), and decrease in estimated glomerular filtration rate to <45mL/min/1.73m2 (CKD<45).

The team found significant differences in local ipsilateral recurrence, CKD10%, and CKD<45 (p<0.001 in all PS analyses). There was no statistical significance in mortality, shown by CSM, ACM, and OCM (p>0.33, p>.034, and p>0.077, respectively in all propensity score analyses). Notably, the lowest p-value was calculated in Re-weighting by stabilized IPWs (p=0.034), but the other three techniques report p>0.16. Distant metastases PS analyses also showed no significant difference (p>0.07 in all PS analyses). Dr. Boris Gershman’s observational study concluded that in using RN versus PN, there is no significant difference regarding mortality.

Presented by: Boris Gershman, MD

Written by: Victoria Lee, Department of Urology, University of California-Irvine at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA