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Patel SH , Uzzo RG , Larcher A , Peyronnet B , Lane BR , Pruthi D , Reddy M , Capitanio U , Joshi S , Noyes S , Eldefrawy A , Ghali F , Meagher MF , Hamilton ZA , Yim K , Nasseri R , Bradshaw AW , Dey S , Kirmiz S , Wan F , Liss MA , Bensalah K , Montorsi F , Derweesh IH
Oncologic and Functional Outcomes of Radical and Partial Nephrectomy in pT3a Pathologically Upstaged Renal Cell Carcinoma: A Multi-institutional Analysis
Clin Genitourin Cancer. 2020 Dec;18(6) :e723-e729
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BACKGROUND: The efficacy of partial nephrectomy (PN) in setting of pT3a pathologic-upstaged renal cell carcinoma (RCC) is controversial. We compared oncologic and functional outcomes of radical nephrectomy (RN) and PN in patients with upstaged pT3a RCC. PATIENTS AND METHODS: This was a multicenter retrospective analysis of patients with cT1-2N0M0 RCC upstaged to pT3a postoperatively. The primary outcome was recurrence-free survival, with secondary outcomes of overall survival and de novo estimated glomular filtration rate (eGFR) < 60. Multivariable analysis was performed to identify predictive factors for oncologic outcomes. Kaplan-Meier analyses (KMA) were obtained to elucidate survival outcomes. RESULTS: A total of 929 patients had pT3a upstaging (686 [72.6%] RN; 243 [25.7%] PN; mean follow-up, 48 months). Tumor size was similar (RN 7.7 cm vs. PN 7.3 cm; P = .083). PN had decreased DeltaeGFR (6.1 vs. RN 19.4 mL/min/1.73m(2); P < .001) and de novo eGFR < 60 (9.5% vs. 21%; P = .008). Multivariable analysis for recurrence showed increasing RENAL score (hazard ratio [HR], 3.8; P < .001), clinical T stage (HR, 1.8; P < .001), positive margin (HR, 1.57; P = .009), and high grade (HR, 1.21; P = .01) to be independent predictors, whereas surgery was not (P = .076). KMA revealed 5-year recurrence-free survival for cT1-upstaged PN, cT1-upstaged RN, cT2-upstaged PN, and cT2-upstaged RN of 79%, 74%, 70%, and 51%, respectively (P < .001). KMA revealed 5-year overall survival for cT1-upstaged PN, cT1-upstaged RN, cT2-upstaged PN, and cT2-upstaged RN of 64%, 65.2%, 56.4%, and 55.2%, respectively (P = .059). CONCLUSIONS: In pathologically upstaged pT3a RCC, PN did not adversely affect risk of recurrence and provided functional benefit. Surgical decision-making in patients at risk for T3a upstaging should be individualized and driven by tumor as well as functional risks.
1938-0682 Patel, Sunil H Uzzo, Robert G Larcher, Alessandro Peyronnet, Benoit Lane, Brian R Pruthi, Deepak Reddy, Madhumitha Capitanio, Umberto Joshi, Shreyas Noyes, Sabrina Eldefrawy, Ahmed Ghali, Fady Meagher, Margaret F Hamilton, Zachary A Yim, Kendrick Nasseri, Ryan Bradshaw, Aaron W Dey, Sumi Kirmiz, Samer Wan, Fang Liss, Michael A Bensalah, Karim Montorsi, Francesco Derweesh, Ithaar H Journal Article United States Clin Genitourin Cancer. 2020 Dec;18(6):e723-e729. doi: 10.1016/j.clgc.2020.05.002. Epub 2020 May 11.