Partial Nephrectomy May Be an Option for T3a Renal Cell Carcinoma

WASHINGTON, DC—Partial nephrectomy (PN) may be considered an alternative to radical nephrectomy (RN) for T3a renal cell carcinoma (RCC) when preservation of kidney function is a priority, investigators concluded in a poster presentation at the Society of Urologic Oncology’s 24th Annual Meeting.

The investigators propensity score matched 345 patients with T3aN0M0 RCC, including 161 and 184 patients receiving RN and PN, respectively. The median follow-up time was 36 months. The 5-year overall survival and cancer-specific survival rates did not differ significantly between PN and RN (87.5% vs 81.3% and 96.1% vs 89.9%, respectively), Cesare Saitta, MD, of the University of California San Diego, and colleagues reported. PN and RN also did not differ significantly in 5-year progression-free survival rates (76.4% vs 73.3%).

Compared with PN, however, RN was significantly associated with 2.7-fold increased odds of new-onset stage 3b chronic kidney disease (defined as a de novo estimated glomerular filtration rate less than 45 mL/min/1.73 m²).

On multivariable analysis, tumor necrosis, positive surgical margin (PSM), and intraoperative transfusion were significantly associated with approximately 3.8-, 3.0-, and 2.4-fold increased risks for all-cause mortality (ACM), respectively. In addition, compared with cT1-T2 tumors, cT3 tumors were significantly associated with a 2.3-fold increased risk for ACM.

Multivariable analysis also revealed that PSMs were significantly associated with a nearly 4.5-fold increased risk for cancer-specific mortality (CSM) and, compared with cT1-T2 tumors, cT3 tumors were significantly associated with a 3.8-fold increased risk for CSM. PSMs also were significantly associated with a 2.6-fold increased risk for cancer recurrence.

RN was not an independent risk factor for all-cause and cancer-specific mortality and recurrence, according to the investigators.

Dr Saitta’s team noted that PN has emerged as the reference standard management for localized renal masses, but the use of PN in T3a RCC is controversial due to concerns about the potential for increased procedure-related complications and oncologic risk.

The current study is not the only research to demonstrate that PN could be an alternative to RN for large renal masses. At the American Urological Association’s 2020 annual meeting, investigators reported on a study of 970 patients with pT3a RCC and no metastases demonstrating that PN is not independently associated with an increased likelihood of cancer recurrence compared with RN.

Reference

Saitta C, Nguyen MV, Autorino R, et al. Comparative analysis of oncological and functional outcomes of radical and partial nephrectomy in pT3a renal cell carcinoma: A multicenter propensity score-matched analysis. Presented at the Society of Urologic Oncology’s 24th Annual Meeting; November 28-December 1, Washington, DC. Poster 94.

This article originally appeared on Renal and Urology News