Oncologic Long-term Outcome of Elective Nephron-sparing Surgery Versus Radical Nephrectomy in Patients With Renal Cell Carcinoma Stage pT1b or Greater in a Matched-pair Cohort

Abstract

To analyze the oncologic outcome and overall survival (OS) for patients with renal cell carcinoma (RCC) >4 cm undergoing radical nephrectomy (RN) or elective nephron-sparing surgery (NSS) in a matched-pair cohort. From 1988 to 2007, we identified 829 patients in our clinic treated with either RN (n = 641) or open NSS (n = 188) for renal masses >4 cm. After matching the cohort for age, time of surgery, grade, TNM stage, tumor size, and sex and excluding patients with metastases, benign lesions with an imperative indication, and those with missing records, 173 remained for oncologic analysis. OS, cancer-specific survival, and progression-free survival were estimated using the Kaplan-Meier method. The association with death was evaluated with Cox proportional hazards regression analysis. At the last follow-up visit, 39 patients had died of any cause and 134 were alive at a median of 7.0 years. RN and elective NSS had been performed in 100 and 73 patients, respectively. The OS (P = .357), progression-free survival (P = .558), and cancer-specific survival (P = .239) were not significantly different between the elective NSS and RN groups using the Kaplan-Meier method. On univariate and multivariate Cox regression analysis, the type of surgery did not have an effect on OS (hazard ratio 1.35, 95% confidence interval 0.71-2.54, P = .359). Our results suggest that it is oncologically safe to perform NSS for renal tumors >4 cm, for which the surgical feasibility according to the tumor location, rather than the tumor size, seemed to be the limiting factor.