ORIGINAL ARTICLE   Free access

Minerva Urology and Nephrology 2022 August;74(4):445-51

DOI: 10.23736/S2724-6051.22.04680-8

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

Partial vs. radical nephrectomy in non-metastatic pT3a kidney cancer patients: a population-based study

Angela PECORARO ¹ ✉, Daniele AMPARORE ¹, Matteo MANFREDI ¹, Federico PIRAMIDE ¹, Enrico CHECCUCCI ¹, Zhe TIAN ², Dario PERETTI ¹, Cristian FIORI ¹, Pierre I. KARAKIEWICZ ², Francesco PORPIGLIA ¹

¹ Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy; ² Unit of Cancer Prognostics and Health Outcomes, University of Montreal Health Center, Montreal, QC, Canada

BACKGROUND: The aim of this study was to test for differences in cancer specific mortality (CSM) rates between radical nephrectomy (RN) and partial nephrectomy (PN) in pT3a nmRCC patients.
METHODS: Within the surveillance, epidemiology, and end results database (2005-2016), 13,177 pT3a patients treated with either PN or RN were identified. Before and after 1:2 ratio propensity score (PS)-match between PN and RN patients, cumulative incidence plot and competing risks regression (CRR) were used to test differences in CSM and other cause mortality (OCM) rates.
RESULTS: Relative to PN (N.=1615, 22.5%), RN patients harbored higher tumor size (72 vs. 38 mm; >70 mm 51 vs.10%), of more aggressive histology, collecting duct (0.4 vs. 0.2%) and sarcomatoid (2.3 vs.0.8%), of higher grade (51.0 vs. 37.5%). After PS-matching and OCM adjustment, 5-year CSM was 3-fold higher after RN than PN (P<0.01). Similarly, after PS matching and CSM adjustment, also 5-year OCM rates were higher after RN (HR: 1.59, P=0.0003).
CONCLUSIONS: PN does not appear to compromise the oncological outcomes in patients with pT3a or high-grade renal masses when compared with RN. Therefore, these concerns should not deter a surgeon from attempting PN when otherwise technically feasible.

KEY WORDS: Mortality; Carcinoma, renal cell; Nephrectomy