Survival after partial and radical nephrectomy for high-risk disease: A propensity-matched comparison.
BACKGROUND
Increasingly, partial nephrectomy has been applied to high-risk disease without evidence that its survival benefits can be extrapolated to this entity. We aimed to compare overall survival after partial vs. radical nephrectomy in patients with high-risk renal cell carcinoma.


METHODS
Using the National Cancer Data Base, we identified patients who underwent partial or radical nephrectomy for high-risk disease between 2003 and 2006. High-risk disease was defined as the presence of adverse pathological features within the primary tumour, namely high-grade or unfavourable histology, T3 stage, or both. After matching the partial and radical nephrectomy groups based on propensity scores, 1680, 276, and 76 patients with high-grade or unfavourable histology, T3 stage, or both adverse pathologic features, respectively, were available for analysis. Five-year overall survival was compared after partial vs. radical nephrectomy for each high-risk cohort using the Kaplan-Meier and log rank tests.


RESULTS
Partial nephrectomy was associated with a statistically significant improvement in five-year overall survival compared to radical nephrectomy for small tumours (median size 3.0 cm; interquartile range 2.1-4.5 cm) with high-grade or unfavourable histology (87% vs. 81%; p<0.01) or with pT3a stage (82% vs. 71%; p<0.01). For patients concomitantly harbouring both adverse pathologic features, no difference in survival was detected (p=0.21).


CONCLUSIONS
Partial nephrectomy is associated with survival benefits in patients with adverse pathologic features, suggesting that renal preservation is not only safe, but also potentially beneficial for high-risk disease. Due to inherent selection bias associated with partial nephrectomy use, prospective validation of these findings is needed.
Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, United States.
Matthew J
MJ
Maurice
Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, United States;; Division of Urology, Louis Stoke Cleveland VA Medical Center, Cleveland, OH, United States.
Hui
H
Zhu
Urology Institute, University Hospitals Case Medical Center, Cleveland, OH, United States.
Simon
S
Kim
Urology Institute, University Hospitals Case Medical Center, Cleveland, OH, United States.
Robert
R
Abouassaly
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