Abstract: PD73-04
Sources of Funding: None

Introduction

Partial nephrectomy (PN) is the recommended treatment for cT1a renal masses. Compared to radical nephrectomy (RN), PN offers comparable cancer specific survival, with better functional outcome. However, there are conflicting results regarding the benefit of PN on overall survival (OS). We sought to compare the OS of patients with a T1 renal mass who underwent PN or RN.

Methods

The American College of Surgeons National Cancer Database of 351,112 patients with kidney cancer was utilized to identify patients 39,346 patients who underwent RN (n=32,665, 83.1%) or PN (n=6,681, 16.9%) for a pT1N0M0 clear cell, chromophobe or papillary renal cell carcinoma from 2003 to 2012. OS for PN vs. RN for at a median follow-up of 4.1 years (IQR 2.3-6.2 years) was compared overall and separately for T1a and T1b renal masses. OS was specifically compared in a multivariable cox proportion hazards regression model adjusting for age, Charlson-Deyo score, race, ethnicity, histology, stage, treatment facility type and other socioeconomic factors.

Results

Patients who underwent RN were more likely to have a T1b renal mass, (48.8% vs. 42.2%, p<.001), be of Hispanic ethnicity (p=.002) and have clear cell vs. chromophobe or papillary RCC (p<.001) There were no differences in age (p=.131), insurance status (p=.927), gender (p=.431), race (p=.076), income (p=.565), year of diagnosis (p=.525), margins (p=.216) between groups. The 5-year OS was 83.0% for RN 82.8% for PN (p=.850). In multivariable analysis, no difference in OS between PN and RN was found for T1 overall (HR=1.01; 95% CI=0.94, 1.08; p=.782), for T1a (HR=1.05; 95% CI=0.96, 1.19; p=.331) or for T1b (HR=0.97; 95% CI=0.87, 1.07; p=.520). Furthermore, OS for PN did not differ for patients ? 75 years old with a T1 renal mass (HR=1.06; 95% CI=0.96, 1.19; p=.251) or patients < 75 years old with a Charlson-Deyo score of 0 and a T1 renal mass (HR=1.01; 95% CI=0.89, 1.09; p=.806).

Conclusions

There was no difference in overall survival between PN and RN with a median follow up of 4.1 years. Longer-term studies are required to determine any impact on OS between PN and RN.

Funding

None