Comparison of survival rates in stage 1 renal cell carcinoma between partial nephrectomy and radical nephrectomy patients according to age distribution: a propensity score matching study

Abstract

ObjectiveTo assess differences in overall survival (OS) between patients receiving partial nephrectomy (PN) and radical nephrectomy (RN) for stage 1 renal cell carcinoma (RCC) according to age distribution, as the survival advantage of PN vs RN has been unclear owing to conflicting data. Patients and MethodsWe studied 952 patients with stage 1 RCC who underwent either PN or RN. Patients were divided into three groups according to age: Group 1 (≤54 years), Group 2 (55-64 years), and Group 3 (≥65 years). Patient variables including age, body mass index, sex, presence of hypertension (HT) and/or diabetes mellitus (DM), performance status, tumour size, pathological diagnosis, nuclear grade, and preoperative estimated glomerular filtration rate (eGFR), were adjusted using 1:1 propensity score matching between PN and RN. ResultsGroup 1 included 66 matched patients; Group 2, 72; and Group 3, 70. Group 1 tended to have higher preoperative eGFR values and lower rates of HT and DM compared with Groups 2 and 3. Postoperative eGFR dropped by 11-13% in PN patients and by 34-36% in RN patients. In Group 3, PN patients had longer OS than RN patients (5-year OS: PN 96%, RN 81%, P = 0.043); however, there was no significant difference in Group 1 (5-year OS: PN 100%, RN 93%, P = 0.302) or Group 2 (5-year OS: PN 94%, RN 87%, P = 0.358). ConclusionsOnly the oldest group of patients showed significantly better OS for PN compared with RN; however, we still recommend PN in young patients.

Ablation versus Resection for Stage 1A Renal Cell Carcinoma: National Variation in Clinical Management and Selected Outcomes

“…With only limited information on comorbidities in the NCDB data, residual confounding might explain inferior long-term results in the thermal ablation subgroup. Extremely low cancer-specific mortality rates for stage 1A RCC further support the assumption that survival differences are driven by unadjusted patients factors rather than differences in treatment effectiveness (32,33). However, patients treated by thermal ablation tend to undergo staging via imaging, which might misclassify T3 tumors with invasion of renal veins as T1a tumors, resulting in higher risk of local recurrence and metastatic spread in these patients (34).…”

“…Our results in the matched cohort indicate that beyond the 1st postoperative year and for patients younger than 65 years, survival was superior for nephrectomy. These age-dependent T1aN0M0 RCC have inherent limitations because associated mortality and metastatic spread rates are low (33). Finally, the NCDB only includes patients who present at participating discrepancies negating the initial benefit of thermal ablation might originate from patient selection and residual confounding: older and frail patients with higher surgical risk tend to be treated by thermal ablation according to recent guidelines (6,9,10,31).…”

Age at diagnosis and the surgical management of small renal carcinomas: findings from a cross‐sectional population‐based study

“…Survival analyses that focused on data only for RCC cases found no difference between treatment arms . Findings from observational studies and matched case–control studies have suggested greater benefits of PN both in terms of kidney function and survival ; however, concerns regarding the quality of the RCT and the non‐randomized nature of observational studies have created some controversy regarding the role of PN in the treatment of small renal tumours . Queensland clinicians’ lower endorsement of PN as the treatment of choice for all T1a tumours may reflect the lack of certainty regarding the benefits of PN, particularly for older patients.…”

“…Laparoscopic RN has been found to have similar oncological outcomes to open RN, with fewer surgical complications and less time in hospital ; however, there is some evidence from patient cohort studies and matched‐control studies that PN may be beneficial in terms of survival and kidney function for older patients . A study matching PN‐ and RN‐treated patients with stage 1 tumours on age, sex and a range of clinical factors, including tumour size, showed significantly longer overall survival for older patients (aged > 65 years) treated with PN compared with RN . Another study taking a similar methodological approach did not find a statistically significant difference in overall survival for a PN‐ compared with an RN‐treated group .…”

Partial nephrectomy vs. radical nephrectomy for stage I renal cell carcinoma in the presence of predisposing systemic diseases for chronic kidney disease

“…On the contrary, the sole prospective study, EORTC 30904, reported no significant difference for the ESRD risk and OS between treatment arms despite lower renal functional loss in PN arm [8,9]. A recent retrospective study supported the EORTC 30904 results in young patients whereas they reported better OS rates in the elderly and better prevention of renal functions for PN in all age groups [15]. This looks like a debate in terms of renal functions for the role of PN in small renal tumors if there is not a role for preventing ESRD or providing survival benefit.…”