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. 2021 Jun 10:11:680842.
doi: 10.3389/fonc.2021.680842. eCollection 2021.

Partial Nephrectomy Versus Radical Nephrectomy for Clinical T2 or Higher Stage Renal Tumors: A Systematic Review and Meta-Analysis

Ruizhen Huang  1 , Chiyu Zhang  1 , Xing Wang  1 , Honglin Hu  1
Affiliations

Partial Nephrectomy Versus Radical Nephrectomy for Clinical T2 or Higher Stage Renal Tumors: A Systematic Review and Meta-Analysis

Ruizhen Huang et al. Front Oncol. .

Abstract

Objective: The choice of surgical method for clinically diagnosed T2 or higher stage kidney cancer remains controversial. Here, we systematically reviewed and collected published comparative studies on renal function, oncologic outcomes, and perioperative results of partial nephrectomy (PN) versus radical nephrectomy (RN) for larger renal tumors (T2 and above), and performed a meta-analysis.

Evidence acquisition: Following searches of PubMed, Web of Science, and Embase, the original studies on PN vs. RN in the treatment of T2 renal cancer were screened through strict inclusion and exclusion criteria. RevMan 5.4 was used for data analysis of the perioperative results, renal function, and oncologic outcomes of the two surgical methods for T2 renal tumor therapy. The weighted mean difference was used as the combined effect size for continuous variables, while the odds ratio (OR) or risk ratio (RR) was used as the combined effect size for binary variables. Both variables used a 95% confidence interval (CI) to estimate statistical accuracy. In cases with low heterogeneity, the fixed-effects model was used to pool the estimated value; otherwise, the random-effects model was used when significant heterogeneity was detected.

Results: Fifteen retrospective studies including 5,056 patients who underwent nephrectomy (PN: 1975, RN: 3081) were included. The decline in estimated GFR (eGFR) after PN was lower than RN [(MD: -11.74 ml/min/1.73 m2; 95% CI: -13.15, -10.32; p < 0.00001)]. The postoperative complication rate of PN was higher than that of PN (OR: 2.09; 95% CI: 1.56, 2.80; p < 0.00001)], and the postoperative overall survival (OS) of PN was higher than that of RN (HR: 0.77; 95% CI: 0.65, 0.90; p = 0.002), and tumor recurrence (RR, 0.69; 95% CI: 0.53, 0.90; p = 0.007). No obvious publication bias was found in the funnel chart of the OS rates of the two groups of patients.

Conclusions: PN is beneficial for patients with T2 renal tumors in terms of OS and renal function protection. However, it is also associated with a higher risk of surgical complications.

Keywords: kidney cancer; meta-analysis; oncologic outcome; partial nephrectomy; radical nephrectomy; renal function.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram of the search strategy and identification of relevant studies (10).
Figure 2
Figure 2
Operative time.
Figure 3
Figure 3
Estimated blood loss.
Figure 4
Figure 4
Length of stay.
Figure 5
Figure 5
Preoperative eGFR.
Figure 6
Figure 6
Postoperative eGFR.
Figure 7
Figure 7
Decline in eGFR.
Figure 8
Figure 8
Complications.
Figure 9
Figure 9
Cancer-specific mortality.
Figure 10
Figure 10
Cancer-specific survival.
Figure 11
Figure 11
Overall survival.
Figure 12
Figure 12
All-cause mortality.
Figure 13
Figure 13
Tumor recurrence.
Figure 14
Figure 14
Funnel plot concerning overall survival.
Figure 15
Figure 15
Subgroup analysis of Fuhrman Grade and cancer histology.
See this image and copyright information in PMC

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