Presentation Authors: Sunil Patel*, Madhumitha Reddy, San Diego, CA, Robert Uzzo, Philadelphia, PA, Alessandro Larcher, Milan, Italy, Ahmet Bindayi, Stephen Ryan, Kendrick Yim, Ryan Nasseri, Zach Hamilton, San Diego, CA, Benoit Peyronnet, Rennes, France, Fan Wang, San Diego, CA, Brian Lane, Grand Rapids, MI, Deepak Pruthi, San Antonio, TX, Umberto Capitanio, Milan, Italy, Alexander Kutikov, Philadelphia, PA, Sumi Dey, Sabrina Noyes, Grand Rapids, MI, Karim Bensalah, Rennes, France, Michael Liss, San Antonio, TX, Francesco Montorsi, Milan, Italy, Ithaar Derweesh, San Diego, CA
Introduction: Radical Nephrectomy (RN) has been the standard of care for complex and locally advanced renal cell carcinoma (RCC). Partial Nephrectomy (PN) utilization has increased in recent years. Efficacy of PN in the setting of pT3a pathologic upstaged disease is controversial. We compared oncologic and functional outcomes of RN and PN in patients with upstaged pT3a RCC.
Methods: We performed a multicenter retrospective analysis of patients with cT1âˆ’2N0M0 RCC undergoing RN or PN upstaged to pT3a postoperatively. Primary outcome was Overall Survival (OS), with secondary outcomes being Recurrence Free Survival (RFS) and eGFR < 60 at last follow-up. Multivariable analysis (MVA) was performed to identify predictive factors for oncologic outcomes. Kaplan Meier analyses (KMA) were obtained to elucidate survival outcomes.
Results: 8185 patients were analyzed (mean follow up 48 months). 945 (11.5%) were upstaged to pT3a [686 (72.6%) RN, 243 (25.7%) PN]. Patients undergoing PN were older (p=0.016) and had higher median RENAL score (10 vs. 9, p < 0.001), though smaller tumor size (7.3 vs. 7.7 cm, p < 0.001). PN was associated with decreased incidence of eGFR < 60 at last follow up (39.6% vs. 59.5% for RN, p=0.008). MVA showed that increasing age was the only independent predictor of all-cause mortality (OR 1.14, 95% CI 1.014 â€“ 1.293, p=0.029). KMA revealed 5âˆ’year OS for PN cT1â†’pT3a, RN cT1â†’pT3a, PN cT2â†’pT3a, RN cT2â†’pT3a of 64%, 65.2%, 56.4% and 55.2% respectively (p=0.059). KMA revealed 5âˆ’year RFS for PN cT1â†’pT3a, RN cT1â†’pT3a, PN cT2â†’pT3a, RN cT2â†’pT3a of 79%, 74%, 70% and 51% respectively (p < 0.001).
Conclusions: PN did not adversely affect oncologic outcomes in select patients who are upstaged to pT3a RCC from cT1 or cT2 disease, and may provide renal functional benefit. The decision to proceed with RN vs. PN in patients at risk for T3a upstaging should be individualized and driven by tumor as well as functional risks. Improvements with respect to RFS for PN are most likely driven by selection bias.