Partial versus radical nephrectomy for T1b-2N0M0 renal tumors: A propensity score matching study based on the SEER database

Mengping Zhang, Zhijian Zhao, Xiaolu Duan, Tuo Deng, Chao Cai, Wenqi Wu, Guohua Zeng, Mengping Zhang, Zhijian Zhao, Xiaolu Duan, Tuo Deng, Chao Cai, Wenqi Wu, Guohua Zeng

Abstract

Purpose: Controversy continues on the tailored therapy for patients with larger renal cell carcinoma (RCC). We investigated whether partial nephrectomy (PN) can improve patient prognosis compared to radical nephrectomy (RN) and the indications for each approach in patients with T1b-2N0M0 RCC.

Materials and methods: A total of 9907 patients were identified from the Surveillance, Epidemiology, and End Results database from 2004 to 2012. Propensity scores were used to balance the selection bias of undergoing PN. Overall (OS) and cancer-specific survival (CSS) of patients undergoing PN and RN were compared. Cases were subdivided to investigate the advantages of each procedure.

Results: Overall, 1418 (14.3%) patients underwent PN. Before matching, PN led to better OS and CSS than RN in both Kaplan-Meier analysis and Cox regression (each p<0.01). For 1412 matched cohorts, PN was no longer associated with significantly better OS (HR: 1.19, 95% CI: 0.98-1.44), but still with a better CSS (HR: 1.66, 95% CI: 1.18-2.27) compared with RN. Further subgroup analysis indicated that patients, who were male, single living, old than 65 years, with T1b stage or clear-cell histologic type, may obtained more oncologic benefit from PN compared to RN.

Conclusions: When tumor localization and technical feasibility have been taken into account, similar long-term survival was achieved in overall among two nephrectomy modalities, but patients, who were male, old than 65 years, with T1b stage or clear-cell histologic type, got a better survival after receiving PN compared to RN.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Kaplan-Meier survival curves demonstrating patients’…
Fig 1. Kaplan-Meier survival curves demonstrating patients’ overall survivals(OS), and cancer-specific survivals (CSS) according to patients’ nephrectomy modalities (partial versus radical) before and after propensity matching.
Fig 2. Forest plot of hazard ratios…
Fig 2. Forest plot of hazard ratios (HRs) for partial (PN) versus radical (RN) nephrectomy in the subgroup analysis.
The diamond on the X-axis indicates the HR and the 95% confident interval (CI) of each subgroup.

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