title: Oncological outcomes of minimally invasive partial versus minimally invasive radical nephrectomy for cT1-2/N0/M0 clear cell renal cell carcinoma: a propensity score-matched analysis.
abstract: OBJECTIVE
  To compare the oncologic outcomes of partial nephrectomy (PN) and radical nephrectomy (RN) for cT1-2/N0 renal tumors and pathologically confirmed pT1-pT3a-pNx clear cell (cc)-renal cell carcinoma (RCC). Few studies compared the oncologic outcomes of PN and RN for renal tumors >7 cm.
  
  
  METHODS
  A prospective "renal cancer" database was queried for cT<3-cN0-cM0 and pT1a-pT3a-pNx cc-RCC. Out of 1650 cases treated between 2001 and 2013, 921 were cc-RCC and 666 met inclusion criteria, 232 of which treated with minimally invasive RN and 434 with MIPN. A 1:1 propensity score-matched (PSM) analysis was employed to minimize the selection bias of non-random assignment of patients to PN as opposed to RN. Kaplan-Meier method was used to compare the oncologic outcomes of the PSM cohorts. Survival rates were computed at 2, 5, and 10 years after surgery, and the log-rank test was applied to assess statistical significance between the two PSM groups.
  
  
  RESULTS
  RN tumors were significantly larger (p < 0.001), with higher pT stages (p < 0.001), higher Fuhrman grades (p = 0.002) and a more frequent sarcomatoid differentiation (p = 0.04). After applying the PSM analysis, the two cohorts of 155 RN and 155 PN cases did not differ for all clinical and pathologic covariates (all p ≥ 0.32). PN and RN cohorts displayed comparable 5-year metastasis-free survival (88.9 vs 89.9 %, p = 0.811), local recurrence-free survival (94.2 vs 95.9 %, p = 0.283), overall survival (94.5 vs 96.8 %, p = 0.419) and cancer-specific survival (96 vs 98.6 %, p = 0.907) rates.
  
  
  CONCLUSIONS
  PN and RN for patients with cc-RCC larger than 7 cm provided equivalent oncologic outcomes. Safety and reproducibility of our findings should be further investigated in larger multicentric cohorts.
authors: Department of Urology, "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy. puldet@gmail.com.
authors: Giuseppe
authors: G
authors: Simone
authors: Department of Urology, "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
authors: Gabriele
authors: G
authors: Tuderti
authors: Department of Urology, "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
authors: Umberto
authors: U
authors: Anceschi
authors: Department of Urology, "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.|Department of Urology, "Campus Biomedico" University, Rome, Italy.
authors: Rocco
authors: R
authors: Papalia
authors: Department of Urology, "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
authors: Mariaconsiglia
authors: M
authors: Ferriero
authors: Department of Urology, "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
authors: Leonardo
authors: L
authors: Misuraca
authors: Department of Urology, "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
authors: Francesco
authors: F
authors: Minisola
authors: Department of Urology, "Campus Biomedico" University, Rome, Italy.
authors: Riccardo
authors: R
authors: Mastroianni
authors: Department of Urology, "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
authors: Manuela
authors: M
authors: Costantini
authors: Department of Urology, "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
authors: Salvatore
authors: S
authors: Guaglianone
authors: Department of Pathology, "Regina Elena" National Cancer Institute, Rome, Italy.
authors: Steno
authors: S
authors: Sentinelli
authors: Department of Urology, "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
authors: Michele
authors: M
authors: Gallucci
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods*; D057216:Propensity Score; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Minimally invasive; Outcomes; Partial nephrectomy; Propensity score matching; Radical nephrectomy; Renal cell carcinoma