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Some patients with renal cancer may not benefit from partial nephrectomy
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Although partial nephrectomy was associated with improved OS among patients with localized renal cancer, the survival advantage was less substantial among a subset of patients with tumors larger than 4 cm, according to study findings published in Cancer.
Further, researchers observed no benefit of partial nephrectomy among those aged 75 years and older in that subset of patients with larger tumors.
“The choice of surgical approach in patients with larger tumors should be driven by a thorough discussion of individualized risks and benefits,” Benjamin T. Ristau, MD, MHA, assistant professor of surgery in urologic oncology at UConn Health, and colleagues wrote.
Partial nephrectomy is recommended for localized T1a (4 cm or less) tumors and is preferred over radical nephrectomy for amenable T1b/T2 (greater than 4 cm) tumors, according to study background.
Ristau and colleagues sought to assess differences in OS between partial and radical nephrectomy among 212,016 patients (mean age, 60.4; standard deviation, 12.6 years) with T1 and T2 renal cell carcinoma included in the National Cancer Database between 2004 and 2014.
Nearly 60% of patients underwent radical nephrectomy, whereas 40.3% of patients underwent partial nephrectomy.
The use of partial nephrectomy increased from 40.6% in 2004 to 71.4% in 2014 among patients with T1a tumors, and from 8.4% to 26.5% among those with T1b/T2 tumors (P < .01).
Although the adjusted 5-year increase in OS was higher among those who underwent partial nephrectomy, researchers observed a decrease in the effect magnitude among those with T1a tumors (89.6% vs. 85.1%; HR = 0.73; 95% CI, 0.7-0.75) and T1b/T2 tumors (82.5% vs. 80.8%; HR = 0.88; 95% CI, 0.83-0.94).
Further, the beneficial effect of partial nephrectomy on OS diminished with increasing age and time from diagnosis. Researchers observed no improvements in OS among the subset of patients aged 75 years and older with T1b/T2 tumors (HR = 0.89; 95% CI, 0.761.06).
Researchers cited the study’s observational design as its principal limitation.
More data are needed to determine the best approach among these subgroups, Ithaar H. Derweesh, MD, professor of urology and radiology at Jacobs Medical Center at UC San Diego Health, and colleagues wrote in an accompanying editorial.
“Ultimately, the most effective and valid way to move the field forward and to answer oncologic and functional questions is a randomized study of partial versus radical nephrectomy in the T1b and T2 subgroup of patients,” they wrote.
“A prospective randomized comparison not only will help answer the obvious oncologic question between the two approaches, but also will provide a translational dividend in our understanding of the behavior of T1b/T2 tumors and the functional consequences of surgery, which is the most overarching benefit for the future,” they added. – by Jennifer Southall
Disclosures: The authors report no relevant financial disclosures. Derweesh reports receiving grants from Pfizer, personal fees from Genentech, and other fees from Novartis outside the submitted work. All other editorial authors report no relevant financial disclosures.
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