Partial Nephrectomy as an Alternative to Radical Nephrectomy for Patients With pT3aN0M0 RCC

A new multi-institutional retrospective analysis compared the efficacy of partial nephrectomy (PN) for patients with pT3aN0M0 renal cell carcinoma (RCC) with radical nephrectomy (RN).

Dr. Cesare Saitta presented the study at the 24th Annual Meeting of the Society of Urologic Oncology.

The trial included patients with pT3aN0M0 RCC who underwent either PN or RN. Patients received PN or RN at the discretion of a team of surgeons. The researchers did not include patients who exhibited clinical metastasis prior to surgery.

Primary outcomes included all-cause mortality (ACM) and overall survival (OS), while secondary outcomes included cancer-specific mortality, cancer-specific survival (CSS), recurrence, and progression-free survival (PFS).

Following propensity score matching, 345 patients were assigned to the RN (n=161; 46.6%) and PN (n=184; 53.3%) groups, with a median follow-up time of 36 months (interquartile range, 14.0-70.5 months).

Investigators used multivariable analysis (MVA) to determine that age (hazard ratio [HR], 1.03; P=.022), tumor necrosis (HR, 3.79; P=.001), surgical margin (HR, 2.97; P=.015), cT3 versus cT1-T2 disease (HR, 2.32; P=.048), and intraoperative transfusion (HR, 2.35; P=.013) were connected to ACM, while RN was not (P=.1) associated.

MVA for recurrence also determined that surgical margin (HR, 2.59; P=.015) is an independent risk factor, while RN is not (P=.400).

Kaplan-Meier analysis showed that 5-year OS for PN and RN was 87.5% and 81.3%, respectively. Five-year CSS was 96.1% and 89.9%, respectively, while 5-year PFS was 76.4% and 73.3%, respectively.

Dr. Saitta and colleagues concluded that PN demonstrates efficacy in the treatment of pT3aN0M0 RCC. “PN may be considered as an alternative to RN in T3a RCC when prioritization of functional preservation is indicated,” they wrote.

Researchers stated that more research is needed to confirm the results.