Can partial nephrectomy provide equal oncological efficiency and safety compared with radical nephrectomy in patients with renal cell carcinoma (≥4cm)? A propensity score-matched study.

Objective: Although partial nephrectomy (PN) is the standard treatment for localized clinical T1a renal cell carcinoma (RCC), treatment of larger renal tumors is controversial. We evaluated the oncological outcomes and perioperative complications after radical and PN for RCC ≥4cm.
Patients and Methods: We retrospectively analyzed the data of 2,373 patients surgically treated for nonmetastatic RCC with clinical T1b or T2 (≥4cm). The propensity scores for surgery type were calculated, and the partial group was matched to the radical group in a 1:3 ratio. The oncological outcomes were compared using Kaplan-Meier analysis and multivariate Cox regression models were used to identify the independent predictors of progression-free, cancer-specific, and overall survival.
Results: All differences in preoperative clinical characteristics disappeared after matching. There were no significant differences in progression-free, cancer-specific, or overall survival between the partial and radical groups in the matched cohort. The patients' age, tumor size, cellular grade, and pathologic stage were independent predictors for all 3 survival outcomes. However, early complications (<30d postoperative) were significantly more common in the partial group (P<0.001). In a subgroup analysis of the patients with clinical T2 stage, there were no significant differences in all 3 survival outcomes.
Conclusions: The partial and radical nephrectomy groups had equivalent oncological outcomes. Although the early complication rate was significantly higher after PN, it should be considered as a valuable treatment option even in patients with clinical T1b or higher RCC.
(Copyright © 2017 Elsevier Inc. All rights reserved.)