Radical versus partial nephrectomy and survival from stage T1 renal cell carcinoma in three prospective cohorts

BackgroundWhether or not a survival difference exists between radical and partial nephrectomy for stage T1 renal cell carcinoma (RCC) is controversial. We therefore aimed to evaluate cancer-specific, other cause, and overall survival among patients undergoing radical or partial nephrectomy for stage pT1 RCC. Materials and methodsWe identified 330 participants with pT1a-b RCC diagnosed between 2000-2015 in three prospective cohort studies and compared treatment with radical nephrectomy (N=196) versus partial nephrectomy (N=134). The primary outcome was overall survival. Secondary outcomes were other-cause and cancer-specific mortality. Kaplan-Meier plots were used to visualize overall survival for the two treatment groups. Cox proportional hazards regression was utilized to compare outcomes between groups, and Fine and Gray competing risks regression was used to compare cancer-specific and other cause mortality between groups. Multivariable models adjusted for age, tumor size, sex, year of diagnosis, body mass index, history of smoking, history of hypertension, surgical technique, and pathological differentiation. ResultsDuring a median follow-up of eight years, overall survival was 84%. We did not detect a statistically significant difference in overall survival between partial and radical nephrectomy (Hazard Ratio (HR) = 0.84, 95% Confidence Interval: 0.40-1.78). There was no significant difference in cause-specific or other cause mortality between groups. This study had 80% power to detect an HR [≥]2.20. ConclusionsThese results did not suggest a difference in long-term survival outcomes between radical and partial nephrectomy.