Partial nephrectomy does not compromise survival in patients with pathologic upstaging to pT2/pT3 or high-grade renal tumors compared with radical nephrectomy

Abstract

Objective: To compare survival in patients with clinical T1b renal tumors that are pathologically upstaged, or high-grade tumors, treated by either partial nephrectomy (PN) or radical nephrectomy (RN). The American Urological Association Guidelines recently advocated increasing use of PN in all patients with cT1 renal masses, but urologists are often hesitant to perform PN for larger more aggressive appearing cT1 renal tumors for fear of pathologic upstaging and a perceived compromise in cancer control.

Methods: From a single institutional kidney cancer registry, 2511 consecutive patients with presumed cT1 renal cell cancer underwent extirpative surgery; 1981 (79%) were found to have renal cell cancer (RCC) and 213 (10.7%) were upstaged on final pathology. In addition, 95 (5%) were found to have grade 4 cancer. Cancer-specific survival (CS) and overall survival (OS) were compared between the groups.

Results: In the upstaged cohort, patients treated by PN (n = 96, 45%) had comparable OS and CS when studied stage for stage with those treated by RN (n = 117, 55%). Multivariate cox-proportional hazards analysis of OS in the upstaged subset demonstrated that only age, grade, and Charlson score predicted OS, whereas PN vs RN and stage did not. PN did not compromise survival in patients with grade 4 RCC compared with RN.

Conclusions: PN does not appear to compromise the chance for cancer cure in patients with cT1 tumors that are upstaged pathologically to pT2 or pT3 or high-grade renal masses when compared with RN. These concerns should not deter a surgeon from attempting PN when otherwise technically feasible.