Partial and Radical Nephrectomy Provides Equivalent Oncologic Outcomes in pT3a Renal Cell Carcinoma: A Population-Based Study.

Jihua Tian,Wei Guan,Xing Zeng,Chunjin Ke,Zhiquan Hu,Chunguang Yang,Jiahua Gan,Jie Wan

doi:10.3389/fonc.2021.819098

Jihua Tian, Wei Guan + Show 6 more

Open Access

https://doi.org/10.3389/fonc.2021.819098

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Abstract

PurposeTo compare the cause-specific survival (CSS) and overall survival (OS) of patients with localized T3a renal cell carcinoma (RCC) after partial nephrectomy (PN) or radical nephrectomy (RN).MethodsWe obtained the demographic and clinicopathological data of 7,127 patients with localized T3a RCC and who underwent PN or RN from the Surveillance, Epidemiology, and End Results (SEER) database. These patients were divided into fat invasion cohort and venous invasion cohort for subsequent analysis. Kaplan–Meier analysis (KMA) and univariate and multivariate Cox proportional hazards regression analyses were used to evaluate the effects of PN or RN on OS and CSS. Meanwhile, 65 cases with clinical T1 (cT1) RCC upstaged to pathological T3a (pT3a) who were treated in Tongji Hospital (TJH) from 2011 to 2020 and underwent PN or RN were identified.ResultsIn the study cohort, 2,085 (29.3%) patients died during the 1–172 months’ follow-up, of whom 1,155 (16.2%) died of RCC. In the two cohorts of fat invasion and venous invasion, KMA indicated that the PN group had favorable survival (p < 0.001). However, after propensity score matching (PSM), univariate and multivariate Cox regression analyses showed that the PN and RN groups had comparable CSS in the fat invasion cohort (p = 0.075) and the venous invasion cohort (p = 0.190). During 1–104 months of follow-up, 9 cases in the Tongji cohort had disease recurrence. There was no significant difference in recurrence-free survival between the RN group and the PN group (p = 0.170).ConclusionsOur analysis showed that after balancing these factors, patients with localized pT3a RCC receiving PN or RN can achieve comparable oncologic outcomes. PN is safe for selected T3a patients.

Highlights

Renal cell carcinoma (RCC) accounts for 2%–3% of all adult malignancies [1]
In the past 10 years, the application of partial nephrectomy (PN) in T3a RCC patients has been explored, more and more evidences show that PN is safe and feasible for some T3a cases [10,11,12,13], and there are dissenting voices suggesting that PN is associated with poor oncologic outcome [14]
We selected the Surveillance, Epidemiology, and End Results (SEER) database to compare the performance of PN and radical nephrectomy (RN) in T3a RCC patients and used propensity score matching (PSM) to control bias; we attached data of clinical T1 (cT1) RCC patients upstaged to pathological T3a (pT3a) from our institution to add new evidence to this controversy

Summary

Introduction

Renal cell carcinoma (RCC) accounts for 2%–3% of all adult malignancies [1]. In recent years, with the wide applications of imaging examinations, the proportion of early-staged RCC has gradually increased [2], and partial nephrectomy (PN) has played a more important role in the treatment of RCC [3, 4].PN is currently the standard treatment for T1 RCC, which provides similar oncologic control to radical nephrectomy (RN) while reducing the loss of renal function [5, 6]. In the past 10 years, the application of PN in T3a RCC patients has been explored, more and more evidences show that PN is safe and feasible for some T3a cases [10,11,12,13], and there are dissenting voices suggesting that PN is associated with poor oncologic outcome [14]. Most of these studies are small-volume and retrospective. We selected the Surveillance, Epidemiology, and End Results (SEER) database to compare the performance of PN and RN in T3a RCC patients and used propensity score matching (PSM) to control bias; we attached data of cT1 RCC patients upstaged to pT3a from our institution to add new evidence to this controversy

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