Partial Nephrectomy Effective in Stage T3a Renal Tumors?

Partial nephrectomy yields similar oncologic outcomes to radical nephrectomy for patients with stage T3a renal tumors after 5 years, according to results of a new study presented at the American Urological Association (AUA) Annual Meeting, held May 6–10 in San Diego, California

“Partial nephrectomy due to primary renal tumor is performed for small lesions and early disease stage,” wrote study authors led by Asaf Shvero, MD, of Chaim Sheba Medical Center in Tel-Hashomer, Israel. “The oncologic outcome of partial nephrectomy for stage T3a renal tumors is not well defined.”

The new study, which included an overall cohort of 2,015 patients with any stage renal tumors who underwent nephrectomy between 1987 and 2014. Among that total cohort, 832 patients with suspected malignant primary tumors underwent partial nephrectomy.

There were 131 patients (15.7%) with stage T3a disease-of those, 19 patients (15%) underwent partial nephrectomy, and 112 patients (85%) were treated with radical nephrectomy. At baseline, radical nephrectomy patients had an average age of 63.6 years, and partial nephrectomy patients were 65.1 years old. Eighty-four percent of partial nephrectomy patients were men, and 63% of radical nephrectomy patients were men.

The median tumor size at baseline was significantly larger in radical nephrectomy patients, at 7 cm compared with 3.5 cm in partial nephrectomy patients (P < .001). Histologic type was no different between the groups.

The 5-year local recurrence rate was 10.5% in the partial nephrectomy patients, and 12.5% in the radical nephrectomy patients (P = .659). The rate of metastatic progression was also no different, at 8.9% in the partial patients and 10.5% in the radical patients (P = .967). The rates of death from the renal tumor were also similar, at 10.5% with partial nephrectomy and 19.6% with radical nephrectomy (P = .278).

The authors noted that the T3a stage was defined after surgery, which does limit interpretation of these results. “According to our data, partial nephrectomy for pathological disease stage T3a yields similar oncologic outcome to radical nephrectomy at 5 years follow-up,” they concluded.