Assessment of cancer control outcomes in patients with high-risk renal cell carcinoma treated with partial nephrectomy

OBJECTIVE: To test whether cancer control outcomes justify the consideration of partial nephrectomy in patients with large tumors (Stage pT2 or greater) or high-grade tumors (Fuhrman grade III-IV) or lesions extending beyond the kidney (Stage pT3a).

METHODS: We abstracted the data for 8847, 11 547, and 5232 patients with tumors >7 cm, Fuhrman grade III-IV, and Stage T3a from the Surveillance, Epidemiology, and End Results database, respectively. All were treated with either partial nephrectomy or radical nephrectomy from 1988 to 2008. The 2- and 5-year cancer-specific mortality rates were compared between the partial nephrectomy and radical nephrectomy groups after propensity score matching. Separate multivariate analyses were conducted within each subcohort and specifically quantified the effect of partial nephrectomy on cancer-specific mortality.

RESULTS: For each of the 3 examined groups, the patients treated with partial nephrectomy failed to demonstrate statistically significant cancer-specific mortality differences relative to radical nephrectomy patients. The hazard ratio for the tumors >7 cm, Fuhrman grade III-IV, and Stage pT3a was 0.67 (95% confidence interval 0.39-1.17, P = .2), 0.81 (95% confidence interval 0.58-1.12, P = .21), and 0.99 (95% confidence interval 0.61-1.61, P = 1.0).

CONCLUSION: Even in patients with adverse pathologic features, partial nephrectomy does not compromise cancer-specific mortality. This implies that when functional outcomes are considered in patients with high-risk features, the decision to perform partial nephrectomy should not depend on the stage or grade, but rather on the technical ability to remove the tumor with a negative margin and provide sufficient functional renal remnant.