Oncologic and Functional Outcomes of Radical and Partial Nephrectomy in pT3a Pathologically Upstaged Renal Cell Carcinoma: A Multi-institutional Analysis |
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| Affiliation: | 1. Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, China;2. Department of Emergency, The Second Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, China;1. Division of Urology, Department of Surgery, VCU Health System, Richmond, VA;2. Urology Unit, Department of Medical and Surgical Specialties, Radiological Science, and Public Health, ASST Spedali Civili, University of Brescia, Brescia, Italy;3. Department of Urology, University of Verona, Verona, Italy;4. Department of Urology, University of Florence, Careggi Hospital, Firenze, Italy;5. Department of Urology, OLV Ziekenhuis, Aalst-Asse-Ninove, Belgium and ORSI Academy, Melle, Belgium;6. USC Institute of Urology, Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA;7. Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy;8. Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA;9. Department of Urology, UC San Diego Health System, La Jolla, CA;10. Department of Urology, University of Turin, “San Luigi Gonzaga” Hospital, Turin, Italy;11. Department of Urology, “Regina Elena” National Cancer Institute, Rome, Italy |
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| Abstract: | BackgroundThe efficacy of partial nephrectomy (PN) in setting of pT3a pathologic-upstaged renal cell carcinoma (RCC) is controversial. We compared oncologic and functional outcomes of radical nephrectomy (RN) and PN in patients with upstaged pT3a RCC.Patients and MethodsThis was a multicenter retrospective analysis of patients with cT1-2N0M0 RCC upstaged to pT3a postoperatively. The primary outcome was recurrence-free survival, with secondary outcomes of overall survival and de novo estimated glomular filtration rate (eGFR) < 60. Multivariable analysis was performed to identify predictive factors for oncologic outcomes. Kaplan-Meier analyses (KMA) were obtained to elucidate survival outcomes.ResultsA total of 929 patients had pT3a upstaging (686 [72.6%] RN; 243 [25.7%] PN; mean follow-up, 48 months). Tumor size was similar (RN 7.7 cm vs. PN 7.3 cm; P = .083). PN had decreased ΔeGFR (6.1 vs. RN 19.4 mL/min/1.73m2; P < .001) and de novo eGFR < 60 (9.5% vs. 21%; P = .008). Multivariable analysis for recurrence showed increasing RENAL score (hazard ratio [HR], 3.8; P < .001), clinical T stage (HR, 1.8; P < .001), positive margin (HR, 1.57; P = .009), and high grade (HR, 1.21; P = .01) to be independent predictors, whereas surgery was not (P = .076). KMA revealed 5-year recurrence-free survival for cT1-upstaged PN, cT1-upstaged RN, cT2-upstaged PN, and cT2-upstaged RN of 79%, 74%, 70%, and 51%, respectively (P < .001). KMA revealed 5-year overall survival for cT1-upstaged PN, cT1-upstaged RN, cT2-upstaged PN, and cT2-upstaged RN of 64%, 65.2%, 56.4%, and 55.2%, respectively (P = .059).ConclusionsIn pathologically upstaged pT3a RCC, PN did not adversely affect risk of recurrence and provided functional benefit. Surgical decision-making in patients at risk for T3a upstaging should be individualized and driven by tumor as well as functional risks. |
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| Keywords: | Carcinoma Chronic kidney disease Nephrectomy Partial nephrectomy Renal cell Stage 3 Survival |
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