Propensity Score-Matched Analysis of Radical and Partial Nephrectomy in pT3aN0M0 Renal Cell Carcinoma

Abstract

Background: We sought to evaluate oncological and functional outcomes of patients treated with partial nephrectomy (PN) and radical nephrectomy (RN) in pT3aN0M0 renal cell carcinoma (RCC).

Patients and methods: We conducted a retrospective analysis of surgically treated pT3aN0M0 RCC patients. Primary outcome was all-cause mortality/overall survival (ACM/OS). Secondary outcomes were cancer-specific mortality/ cancer-specific survival (CSM/CSS), recurrence/progression free survival (PFS) and new onset de novo eGFR < 45 mL/min/1.73 m² (CKD-S3b). A propensity score matched model in a 1:1 ratio was conducted, within a caliper width of 0.01. Kaplan-Meier analysis (KMA) and Cox multivariable analysis (MVA) were fitted to delineate survival outcomes and their predictors.

Results: After PSM 359 were analyzed (PN = 179 vs. RN = 180); median follow up of 38.7 (IQR 16.28-64) months. MVA for ACM revealed, high grade (HR 2.05, P = .019), and CKD-S3b at last follow up (HR 2.13, P = .018) as independent risk factors, while RN versus PN (P = .41) was not. MVA for CSM and recurrence revealed that RN versus PN was not an independent risk factor for CSM (P = .088) and recurrence (P = .277). MVA for CKD-S3b revealed RN versus PN (HR 1.67 P = .025) as associated with increased risk of CKD-S3b. KMA comparing PN versus RN revealed 5-year OS of 87.4% versus 82% (P = .26); 5-year CSS of 95.6% versus 90.3% (P = .15); 5-year PFS of 83.5% versus 77% (P = .38); 5-year CKD-S3b free survival of 80.8% versus 65.5% (P = .016).

Conclusion: PN exhibited oncological equipoise while reducing risk of development of eGFR < 45 mL/min/1.73 m². PN may be considered in T3a RCC when prioritization of functional preservation is indicated.

Keywords: Nonmetastatic renal cell carcinoma; Propensity score match; Radical nephrectomy; Survival outcome; pT3a.