title: Partial Nephrectomy is Associated with Higher Risk of Relapse Compared with Radical Nephrectomy for Clinical Stage T1 Renal Cell Carcinoma Pathologically Up Staged to T3a.
abstract: We studied recurrence-free survival after partial vs radical nephrectomy for clinical stage T1 renal cell carcinoma in all patients and in those up staged to pathological stage T3a.
  
  
  
  We retrospectively reviewed the records of 1,250 patients who underwent partial or radical nephrectomy for clinically localized T1 renal cell carcinoma between 2006 and 2014. Recurrence-free survival was estimated using the Kaplan-Meier method and evaluated as a function of nephrectomy type with the log rank test and Cox models, adjusting for clinical, radiological and pathological characteristics.
  
  
  
  A total of 86 recurrences (7%) were observed during a median followup of 37 months. No difference in recurrence-free survival between partial and radical nephrectomy was found among all clinical stage T1 renal cell carcinomas. T3a up staging was noted in 140 patients (11%) and recurrent disease was observed in 44 (31.4%) during a median followup of 38 months. Among up staged T3a cases partial nephrectomy was associated with shorter recurrence-free survival compared to radical nephrectomy on univariable analysis (recurrence HR 2.04, 95% CI 1.12-3.68, p = 0.019) and multivariable analysis (recurrence HR 5.39, 95% CI 1.94-14.9, p = 0.001).
  
  
  
  In a subgroup of patients clinically staged T1 renal cell carcinoma will be pathologically up staged to T3a. Among these patients those who undergo partial nephrectomy appear to have inferior recurrence-free survival relative to those who undergo radical nephrectomy.
authors.affiliation: Department of Urology, Smith Institute for Urology, Northwell Health, New Hyde Park, New York. Electronic address: pshah1023@gmail.com.
authors.forename: Paras H
authors.initials: PH
authors.lastname: Shah
authors.affiliation: Department of Urology, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Moreira
authors.affiliation: Department of Urology, Smith Institute for Urology, Northwell Health, New Hyde Park, New York.
authors.forename: Vinay R
authors.initials: VR
authors.lastname: Patel
authors.affiliation: Department of Urology, Smith Institute for Urology, Northwell Health, New Hyde Park, New York.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Gaunay
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Arvin K
authors.initials: AK
authors.lastname: George
authors.affiliation: Department of Urology, Smith Institute for Urology, Northwell Health, New Hyde Park, New York.
authors.forename: Manaf
authors.initials: M
authors.lastname: Alom
authors.affiliation: Department of Urology, Smith Institute for Urology, Northwell Health, New Hyde Park, New York.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Kozel
authors.affiliation: Department of Urology, Smith Institute for Urology, Northwell Health, New Hyde Park, New York.
authors.forename: Oksana
authors.initials: O
authors.lastname: Yaskiv
authors.affiliation: Department of Urology, Smith Institute for Urology, Northwell Health, New Hyde Park, New York.
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Hall
authors.affiliation: Department of Urology, Smith Institute for Urology, Northwell Health, New Hyde Park, New York.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Schwartz
authors.affiliation: Department of Urology, Smith Institute for Urology, Northwell Health, New Hyde Park, New York.
authors.forename: Manish A
authors.initials: MA
authors.lastname: Vira
authors.affiliation: Department of Urology, Smith Institute for Urology, Northwell Health, New Hyde Park, New York.
authors.forename: Lee
authors.initials: L
authors.lastname: Richstone
authors.affiliation: Department of Urology, Smith Institute for Urology, Northwell Health, New Hyde Park, New York.
authors.forename: Louis R
authors.initials: LR
authors.lastname: Kavoussi
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000517:prevention & control; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods; D018579:Patient Selection; D012189:Retrospective Studies
keywords: carcinoma; kidney neoplasms; mortality; neoplasm staging; nephrectomy; renal cell