Similar Survival Seen With Partial, Radical Nephrectomy in Clinical T2 Renal Masses

Partial nephrectomy may be just as effective as radical nephrectomy for the surgical removal of clinical T2 renal masses, results of a new study indicate.

Partial nephrectomy may be just as oncologically effective as radical nephrectomy for the surgical removal of clinical T2 renal masses, results of a new study indicate. Patients who underwent a partial compared with a radical procedure had similar rates of progression-free, cancer-specific, and overall survival.

According to the study, partial nephrectomy is currently the preferred surgical option for small renal masses; however, there are fewer data supporting the use of partial nephrectomy compared with radical nephrectomy in clinical T2 renal masses.

Ryan P. Kopp, MD, of UC San Diego Health System, and colleagues designed this study to evaluated survival outcomes in patients undergoing the two procedures, controlling for RENAL nephrectomy score when available. The study included 202 patients with clinical T2 renal masses who underwent radical nephrectomy (n = 122) or partial nephrectomy (n = 80) between July 2002 and June 2012. For comparison, patients were divided according to whether they had RENAL scores of 10 or more or less than 10.

The researchers found no significant differences in overall survival, cancer-specific survival, or progression-free survival between patients who underwent radical nephrectomy and those who underwent partial nephrectomy.

“When the entire cohort (partial nephrectomy and radical nephrectomy) was broken down into cT2a and cT2b groups, there was no difference in overall survival and cancer-specific survival between the T2a and T2b groups,” the researchers wrote in BJU International. “Conversely, progression-free survival was significantly worse for cT2b compared with cT2a, which may be consistent with TNM 2010 separation of T2a and T2b, while a greater proportion of radical nephrectomies in the cT2b group may be evidence of selection bias.”

The analysis also revealed  that patients with a RENAL score of less than 10 had significantly better overall survival, cancer-specific survival, and progression-free survival compared with those with scores of 10 or greater (P < .001 for all). In fact, patients with a score of 10 or greater had a more than fivefold risk of disease recurrence and a sevenfold risk of death from any cause.

Patients undergoing the two procedures had similar overall complications rates, but those patients undergoing radical nephrectomy did have higher rates of major complications.