Certain RCC Subgroups May Benefit From Partial vs Radical Nephrectomy

March 7, 2018

In a large Chinese study, in certain RCC subgroups cancer-specific survival outcomes were better with partial rather than radical nephrectomy.

Undergoing partial nephrectomy led to outcomes similar to those seen with radical nephrectomy in patients with T1b-2N0M0 renal cell carcinoma (RCC) tumors, according to the results of a recent study. However, certain subgroups of patients may obtain more benefit from a partial procedure.

“When tumor localization and technical feasibility have been taken into account, similar and even better long-term survival can be achieved with partial nephrectomy in patients with T1b-2N0M0 tumors compared to radical nephrectomy, especially when patients were male, older than 65 years, with T1b stage or clear-cell histologic type,” Mengping Zhang, of The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China, and colleagues wrote in PLoS One.

While nephrectomy is still a common treatment for patients with localized RCC, there are no strong recommendations on whether to use partial or radical nephrectomy for localized RCC tumors larger than 4 cm. With this study, Zhang and colleagues wanted to examine if individual patient or tumor characteristics affected the efficacy of the two modalities.

The researchers identified 9,907 patients from the Surveillance, Epidemiology, and End Results database from 2004 to 2012. All patients had T1b-2N0M0 RCC after partial or radical nephrectomy. Propensity scores were used to balance selection bias of patients undergoing partial nephrectomy, and outcomes of partial and radical surgical procedures were compared.

Patients who underwent partial nephrectomy were significantly more likely to be male and to have smaller tumors, lower T stage, and a lower proportion of tumors with clear cell histology. After propensity score matching, preoperative characteristics were well matched.

Of the 9,907 patients, 1,418 underwent partial nephrectomy. Before propensity matching, undergoing partial nephrectomy was associated with better overall survival and cancer-specific survival compared with a radical procedure.

When the researchers looked at the 1,412 matched cohorts, partial nephrectomy was no longer associated with an improved overall survival, but the procedure was still linked with a better cancer-specific survival (hazard ratio, 1.66; 95% CI, 1.18–2.27) compared with radical nephrectomy.

Looking at certain subgroups, the data indicated that patients who were male, single, older than 65 years of age, and whose tumors had stage T1b or clear cell histology benefitted more from a partial nephrectomy procedure.

The researchers pointed out that one limitation to the study was a lack of information about comorbidities and performance status.

“It is possible that patients undergoing surgical resection may be relatively healthy at baseline and deemed fit to tolerate operation, however, potential selection bias could not be totally excluded,” the researchers wrote.