Elsevier

Urology

Volume 67, Issue 2, February 2006, Pages 260-264
Urology

Adult urology
Partial nephrectomy and radical nephrectomy offer similar cancer outcomes in renal cortical tumors 4 cm or larger

https://doi.org/10.1016/j.urology.2005.08.057Get rights and content

Abstract

Objectives

To determine whether the type of surgery (partial nephrectomy [PN] versus radical nephrectomy [RN]) has any effect on cancer outcome for renal cortical tumors 4 cm or larger. PN outcomes for large renal cortical tumors have been shown to be worse than outcomes for smaller tumors, but the upper limit of tumor diameter amenable to PN remains controversial.

Methods

We identified 33 patients from the Columbia University Comprehensive Urologic Oncology Database who underwent PN between 1988 and 2004 for renal cortical tumors 4 cm or larger. Each was matched with 2 patients undergoing RN on the basis of the tumor diameter. A survival analysis was conducted using the Kaplan-Meier method, and any differences between the two groups were compared using the log-rank test. The Cox regression model was used to determine which variables affected survival.

Results

The estimated 5-year recurrence-free survival rate was 93.5% for the PN group and 83.3% for the RN group (P = 0.471). The estimated 5-year disease-specific survival rate was 96.2% for the PN group and 97.8% for the RN group (P = 0.893). Only tumor diameter had an impact on recurrence-free survival in the univariate (P = 0.005) and multivariate (P = 0.008) Cox regression models. Surgical technique had no impact on disease recurrence.

Conclusions

The results of our study have shown that cancer outcomes after PN do not differ from outcomes after RN for tumors of 4 cm or greater in diameter. The upper limit of 4 cm appears to have been determined arbitrarily. It is no longer advisable to restrict PN to patients with tumors smaller than 4 cm in diameter.

Section snippets

Material and methods

The Columbia University Comprehensive Urologic Oncology Database (approved by Columbia’s institutional review board) was reviewed, and 830 patients were identified who had undergone renal surgery for presumed RCTs from 1988 to 2004. Of these, 256 (30.1%) had undergone PN. From this cohort, 71 (8.6% of all nephrectomy patients) were identified who had undergone PN for tumors 4 cm or greater. Patients with lymph node metastases, distant metastatic disease, prior renal surgery, genetic syndromes,

Results

The clinicopathologic data are displayed in Table I. No significant differences were found between the PN and RN groups on the basis of age, sex, histologic subtype, tumor diameter, or grade. At analysis, 28 patients (84.8%) in the PN group had no evidence of disease progression versus 52 (78.8%) in the RN group. Additionally, 1 patient (3.0%) in the PN group was alive with disease versus 8 (12.1%) in the RN group; 1 patient (3.0%) in the PN group had died of the disease versus 3 (4.5%) in the

Comment

Although it is established that PN can provide cancer control rates similar to RN for tumors 4 cm or less, the particular subset of patients to whom PN should be offered remains controversial.8 In 1993, Licht and Novick9 wrote that the indications for PN should be limited to situations in which RN would render a patient anephric and situations in which the function of the opposite kidney would be likely to be compromised in the future. As long-term follow-up data became available, however, the

Conclusions

The results of this study found that cancer outcomes after PN do not differ from the outcomes after RN for tumors of 4 cm or greater. The widely accepted upper limit of 4 cm appears to have been determined rather arbitrarily from studies that did not compare PN results with RN results. In light of this evidence, as well as data from Patard et al.6 and Leibovitch et al.,5 it is no longer advisable to restrict nephron-sparing surgery to patients with tumors smaller than 4 cm in diameter.

Cited by (100)

View all citing articles on Scopus
View full text