We aimed to study recurrence-free survival after partial versus radical nephrectomy for clinical stage T1 renal cell carcinoma among all comers and those upstaged to pathologic stage T3a.
A retrospective review of 1250 patients undergoing partial nephrectomy or radical nephrectomy for clinically localized T1 renal cell carcinoma between 2006 and 2014 was performed. Recurrence-free survival was estimated using the Kaplan-Meier method and evaluated as a function of nephrectomy type with log-rank test and Cox models adjusting for clinical, radiological, and pathological characteristics.
A total of 86 (7%) recurrences were observed over a median follow-up of 37 months. No difference in recurrence-free survival between partial and radical nephrectomy was appreciated among all clinical stage T1 renal cell carcinomas. T3a upstaging was encountered in 140 (11%) cases with disease recurrence observed in 44 (31.4%) patients over a median follow-up of 38 months. Among upstaged T3a patients, partial nephrectomy was associated with shorter recurrence-free survival compared to radical nephrectomy in both uni- (recurrence HR=2.04, 95%CI=1.12-3.68, P=0.019) and multivariable analyses (recurrence HR=5.39, 95%CI=1.94-14.9, P=0.001).
For clinically staged T1 renal cell carcinoma, a subgroup of patients will be pathologically upstaged to T3a. Among these patients, those undergoing partial nephrectomy appear to have inferior recurrence-free survival relative to those undergoing radical nephrectomy.
The Journal of urology. 2017 Mar 05 [Epub ahead of print]
Paras H Shah, Daniel M Moreira, Vinay R Patel, Geoffrey Gaunay, Arvin K George, Manaf Alom, Zachary Kozel, Oksana Yaskiv, Simon J Hall, Michael J Schwartz, Manish A Vira, Lee Richstone, Louis R Kavoussi
Department of Urology, Smith Institute for Urology, Northwell Health, New Hyde Park, NY. Electronic address: ., Department of Urology, University of Illinois at Chicago, Chicago, IL., Department of Urology, Smith Institute for Urology, Northwell Health, New Hyde Park, NY., Department of Urology, University of Michigan, Ann Arbor, MI.