Partial nephrectomy efficacious for clinical T2 renal masses

By Shreeya Nanda, Senior medwireNews Reporter

Survival outcomes and overall complication rates of partial nephrectomy (PN) for clinical T2 renal masses (cT2RM) are comparable to those of radical nephrectomy (RN) when the pathological staging, histology and grading of the tumours are similar, researchers report.

Although PN is preferentially used for the management of small renal masses, the data available on PN for cT2RM are inconsistent, and there are few studies directly comparing PN and RN for cT2RM, the team explains in the BJU International.

Ithaar Derweesh (Moores UCSD Cancer Center, La Jolla, USA) and colleagues found no difference between patients who underwent PN (n=80) and those who were treated with RN (n=122) in terms of overall survival (83.3 and 80.0%, respectively), cancer-specific survival (86.7 and 82.5%, respectively) and progression-free survival (79.9 and 69.8%, respectively) with a median follow-up of 41.5 months.

The authors controlled for tumour anatomy as a source of selection bias by including, where available, the RENAL nephrometry score, which provides a more complete description of tumour anatomical characteristics other than just size. The RENAL nephrometry scores were similar for the two groups, indicating that the tumours were anatomically comparable.

Interestingly, patients with complex RENAL scores (10–12 points) had a significantly increased risk of disease progression (hazard ratio [HR]=5.31) and were significantly more likely to die from any cause (HR=7.55), compared with those who had a simple or intermediate RENAL nephrometry score (<10 points).

The authors explain that their findings suggest a prognostic role for the RENAL nephrometry score, and add that “size may not be the only anatomical feature to consider when counselling patients with cT2RM”.

The overall rate of complications was the same between the PN and RN groups; however, major complications, such as urine leaks and re-intubation, were more common in the PN group compared with the RN cohort.

Derweesh et al point out that their analysis may have been underpowered to detect a significant difference between the surgical groups. Nevertheless, they conclude that their study “represents the largest cohort of PN for cT2RM whose outcomes have been presented in a comparative manner.”

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