Who can benefit from a partial nephrectomy in renal cell carcinoma?

By Robyn Boyle, RPh, for MDLinx
Published March 27, 2018

Key Takeaways

Partial nephrectomy (PN) was beneficial in male patients who were 75 years or younger with renal cell carcinoma (RCC) confined to the kidney, according to a study published in Urologia Internationalis. However, the procedure did not improve overall survival (OS) in women or in men older than 75 years.

International guidelines recommend PN as the standard surgical treatment for pT1 RCC; some guidelines also quantify the tumor size. However, little evidence exists concerning the overall survival benefit after PN or radical nephrectomy (RN) in patients with small RCC in relation to patient age.

Elisabeth Liek from the St. Georg Clinic Eisenach in Germany and colleagues, used information from a cancer database in Germany to compare PN to RN in patients with T1 RCC. They then evaluated the effects of age and gender on rate of OS.

The retrospective multicenter study analyzed data of 2,242 RCC patients including age, gender, tumor stage, surgical method, and overall survival. Of these, 1,032 patients had PN and 1,210 underwent RN.

Over the ten-year study period, the rate of PN increased from 27.0% to 82.3%, which the authors noted is consistent with international trends. The mean overall age of patients in the study was 64.8 years; mean age of males was 64.0 years, and 66.1 years for females.

Regardless of age and gender, there was an OS benefit for all patients treated by PN (P= 0.0002), but this significant OS benefit was seen only in male patients (P= 0.0006). In female patients, there was no significant OS outcome benefit (P= 0.0629), regardless of age.

Based on age, only male patients ≤75 years of age with T1 RCC showed a significant OS benefit (P= 0.0005) for PN; a survival benefit was not found in males older than 75 years (P= 0.736).

For women with PN, regardless of age, there was no statistically significant benefit in OS. Male and female patients older than 75 years of age showed the same prognostic data after RN or PN.

All female patients ≤75 years of age treated by RN or PN, as well as male patients ≤75 years of age after nephron-sparing surgery, were found to be in similar status in terms of OS.

The worst OS was reported in males ≤75 years with T1 RCC treated with RN.

In this study, a minimal life expectancy of more than 45 months was necessary to notice an OS benefit of PN. An OS benefit for PN was seen only with longer follow-up (mean: 126 months) of patients treated during the first half of the study (from 2000–2005), but not for PN performed during 2006–2015 (mean follow-up time: 45 months).

“We believe that nephron-sparing surgery in female patients and patients who are more than 75 years old appears to have less of a benefit over RN,” concluded the authors.

Moreover, the investigators suggested that reconsideration of the guidelines of performing a partial over a radical nephrectomy in T1 RCC is warranted based on the results of this study.

To read more about this study, click here.

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