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Partial nephrectomy versus radical nephrectomy for non‐metastatic pathological T3a renal cell carcinoma: A multi‐institutional comparative analysis
Author(s) -
Oh Jong Jin,
Byun SeokSoo,
Lee Sang Eun,
Hong Sung Kyu,
Lee Eun Sik,
Kim Hyeon Hoe,
Kwak Cheol,
Ku Ja Hyeon,
Jeong Chang Wook,
Kim YongJune,
Kang Seok Ho,
Hong Sung Hoo
Publication year - 2014
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/iju.12283
Subject(s) - nephrectomy , medicine , renal cell carcinoma , pathological , urology , proportional hazards model , surgery , kidney
Objectives To compare the recurrence‐free survival of partial nephrectomy and radical nephrectomy in patients with non‐metastatic pathological T3a renal cell carcinoma. Methods We reviewed the records of 3567 patients who had undergone a nephrectomy for renal cell carcinoma at five institutions in K orea from J anuary 2000 to D ecember 2010. The clinical data of 45 patients with pathological T3a renal cell carcinoma in the partial nephrectomy group were compared with 298 patients with pathological T3a renal cell carcinoma in the radical nephrectomy group. The effects of surgical methods on recurrence‐free survival were assessed by a multivariate C ox proportional hazard analysis. All comparisons were repeated in subgroup analysis on 63 clinical T1a patients with tumors ≤4 cm. Results During a median 43‐month follow‐up period, disease recurrence occurred in two patients (4.4%) in the partial nephrectomy group, and 94 patients (31.5%) in the radical nephrectomy group. The results from a multivariate model showed that radical nephrectomy was a significant predictor of recurrence. However, in subgroup analysis that included 63 clinical T1a pathological T3a patients, the recurrence‐free survival rates were not significantly different between the two cohorts. The renal function was significantly better preserved in the partial nephrectomy cohort than in the radical nephrectomy cohort. Conclusions Partial nephrectomy provides similar recurrence‐free survival outcomes compared with radical nephrectomy in patients with clinical T1a pathological T3a renal cell carcinoma. However, there seems to be a higher risk of recurrence for large pathological T3a tumors treated by radical nephrectomy compared with small tumors treated by partial nephrectomy. Thus, large tumors with the same pathological T3a renal cell carcinoma grade could have hidden aggressive features.