By Lucy Piper, Senior medwireNews Reporter
Partial nephrectomy (PN) and radical nephrectomy (RN) provide comparable cancer control for T1b renal cell carcinoma (RCC), yet use of the less radical approach has remained limited in the USA over recent years, study results show.
The findings, based on Surveillance, Epidemiology, and End Results data, showed a “notable slow adoption of PN,” report the study researchers, with a small 0.9% yearly increase in PN use between 1988 and 2008, from 1.2% to 15.9%.
This is despite there currently being “a strong body of literature supporting the use of PN over RN for T1a RCC,” they say.
“Benefits of nephron sparing include better renal function outcomes, lower rates of cardiovascular-related outcomes and overall survival,” points out the team, led by Malek Meskawi (University of Montreal Health Center, Quebec, Canada).
They found that among the 16,333 patients with T1bN0M0 RCC treated between 1998 and 2008, those receiving PN tended to be younger, male, and have smaller tumors.
“Such results plausibly reflect difficulty in carrying out PN with increasing tumor size, as well as a cautious attitude towards the consideration of a nephron-sparing approach amongst surgeons treating more complex cases,” Malek et al write in the International Journal of Urology.
They found no difference in cancer-specific mortality between the nephrectomy types following propensity-score matching.
The 5- and 10-year cancer-specific mortality rates were 4.4% and 6.1%, respectively, for the 1526 individuals receiving PN, and 6.0% and 10.4%, respectively, for the 6104 patients treated with RN. Similarly, there was no difference in overall survival between RN and PN.
Multiple regression analysis also indicated nephrectomy type was not significantly associated with cancer-specific mortality.
While these findings support the relative safety of PN with regard to postoperative functional and oncologic outcomes, the researchers note that the lack of a survival advantage with PN over RN may make PN less appealing.
But in a related editorial Tsunenori Kondo (Tokyo Women’s Medical University, Japan) gives several reasons, in addition to comparable safety, why PN should be considered over RN.
He comments that RN can mean overtreatment in tumors that turn out to be benign, is associated with an approximate 5% risk for metachronous development of RCC tumors in the contralateral kidney, and can limit future anticancer treatment by causing renal function to deteriorate.
“I believe that PN should be considered as much as possible, even though [cancer-specific survival] and [overall survival] are comparable between PN and RN in this group,” Kondo concludes.
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