Partial versus radical nephrectomy in patients with adverse clinical or pathologic characteristics.
OBJECTIVE
To assess cancer-specific survival of partial nephrectomy (PN) patients with >or= 7-cm lesions or unfavorable pathology (stage T3a or Fuhrman grades III-IV).


METHODS
At 13 participation centers, 4072 partial or radical nephrectomies (RN) were performed for RCC between 1984 and 2001. Of all procedures, 925 (22.7%) were for tumors > 7 cm, 973 (23.9%) had Fuhrman grades III or IV, and 861 (21.1%) had stage pT3a. None had nodal or distant metastases. Matched (age, gender, tumor size, T stage, histologic subtype, and Fuhrman grade [FG]) survival analyses addressed the effect of nephrectomy type (partial vs radical) on cancer-specific mortality.


RESULTS
Partial nephrectomy for tumors > 7 cm was associated with higher mortality than RN (HR = 5.3; P = .025). No significant cancer-specific survival differences were recorded after PN for FG III-IV (HR = 0.7, P = .5) or for pT3a lesions (HR = 2.5, P = .9).


CONCLUSIONS
Partial nephrectomy may undermine cancer control in patients with tumors > 7 cm. Conversely, after PN, the same cancer control rates as after RN may be expected in patients with Fuhrman grades III-IV or with pT3a histology.
Cancer Prognostics and Health Outcomes Unit, University of Montreal, Health Center, Montreal, Quebec, Canada.
Claudio
C
Jeldres
Jean-Jacques
JJ
Patard
Umberto
U
Capitanio
Paul
P
Perrotte
Nazareno
N
Suardi
Maxime
M
Crepel
Vincenzo
V
Ficarra
Luca
L
Cindolo
Alexandre
A
de La Taille
Jacques
J
Tostain
Christian
C
Pfister
Baptiste
B
Albouy
Marc
M
Colombel
Arnaud
A
Méjean
Hervé
H
Lang
Didier
D
Jacqmin
Jean-Christophe
JC
Bernhard
Jean-Marie
JM
Ferrière
Karim
K
Bensalah
Pierre I
PI
Karakiewicz
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate; D055815:Young Adult