Abstract
PurposeControversy continues on the tailored therapy for patients with larger renal cell carcinoma (RCC). We investigated whether partial nephrectomy (PN) can improve patient prognosis compared to radical nephrectomy (RN) and the indications for each approach in patients with T1b-2N0M0 RCC.Materials and methodsA total of 9907 patients were identified from the Surveillance, Epidemiology, and End Results database from 2004 to 2012. Propensity scores were used to balance the selection bias of undergoing PN. Overall (OS) and cancer-specific survival (CSS) of patients undergoing PN and RN were compared. Cases were subdivided to investigate the advantages of each procedure.ResultsOverall, 1418 (14.3%) patients underwent PN. Before matching, PN led to better OS and CSS than RN in both Kaplan-Meier analysis and Cox regression (each p<0.01). For 1412 matched cohorts, PN was no longer associated with significantly better OS (HR: 1.19, 95% CI: 0.98–1.44), but still with a better CSS (HR: 1.66, 95% CI: 1.18–2.27) compared with RN. Further subgroup analysis indicated that patients, who were male, single living, old than 65 years, with T1b stage or clear-cell histologic type, may obtained more oncologic benefit from PN compared to RN.ConclusionsWhen tumor localization and technical feasibility have been taken into account, similar long-term survival was achieved in overall among two nephrectomy modalities, but patients, who were male, old than 65 years, with T1b stage or clear-cell histologic type, got a better survival after receiving PN compared to RN.
Highlights
Renal cell carcinoma (RCC) represents 2–3% of all cancers and 85–93% of renal malignant tumors[1]
For 1412 matched cohorts, partial nephrectomy (PN) was no longer associated with significantly better Overall survival (OS) (HR: 1.19, 95% confidential interval (CI): 0.98–1.44), but still with a better cancer-specific survival (CSS) (HR: 1.66, 95% CI: 1.18–2.27) compared with radical nephrectomy (RN)
Further subgroup analysis indicated that patients, who were male, single living, old than 65 years, with T1b stage or clear-cell histologic type, may obtained more oncologic benefit from PN compared to RN
Summary
Renal cell carcinoma (RCC) represents 2–3% of all cancers and 85–93% of renal malignant tumors[1]. Mainly from retrospective studies, indicates that PN may obtain oncologic outcomes similar or superiority to RN in larger renal masses (T1b–2), and their data were further systemically evaluated in a meta-analysis to compare the renal functional, oncologic, and perioperative outcomes[4]. The meta-analysis has many limitations[4] It is not clear whether these disparate results are related to selection bias in observational studies or inadequate statistical power with small size of patients or short follow-up. These inconsistent results raise the question of whether and how individual patient and tumor characteristics may impact the efficacy of nephrectomy modalities. Whereas meta-analysis of homogeneous studies are the highest form of evidence, poorly conducted meta-analysis create confusion and serve to harm the patient[5]
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