Partial nephrectomy may offer younger renal cancer patients survival advantage

Feb 25 2014

By Sara Freeman, medwireNews Reporter

Partial nephrectomy may offer younger patients with localized renal cancer a distinct survival advantage compared with the complete removal of the kidney, US research suggests.

Overall survival at 10 years was 94.0% with nephron-sparing surgery and 89.7% with radical nephrectomy, with a hazard ratio of 0.50.

Radical nephrectomy increases the risk of chronic kidney disease and thus may reduce patient survival. Although partial nephrectomy has been shown to increase survival in older kidney cancer patients, the presence of comorbidities in these patients may mean the findings do not apply to younger patients.

“To minimize the confounding effects of comorbidity observed in the older population, we designed a study to analyze the effects of preserved renal function in young patients,” explain Michael Daugherty and Gennady Bratslavsky (SUNY Upstate Medical University, Syracuse, New York).

“We hypothesized that the long-standing effects of renal preservation would manifest a survival advantage in a younger patient population where lower medical comorbidities would allow for surgically caused renal insufficiency to manifest at long term follow up,” the researchers write in Urologic Oncology.

A retrospective, nonrandomized analysis was performed on data collated by the Surveillance, Epidemiology, and End Results (SEER) database between 1993 and 2003. Patients were included in the analysis if they were aged 20–44 years and had undergone partial (n=222) or radical (n=494) nephrectomy for localized, small (≤4 cm) renal cell carcinoma (RCC) of known grade and histology.

There was no difference in patient characteristics between the two study groups, with the majority of patients being male, of White race, and aged 35 years or older. Similar tumour characteristics were also present, with most patients having moderately differentiated tumours and clear-cell or renal-cell histology.

No difference in 5- or 10-year cancer-specific survival was seen following partial or radical nephrectomy. There was also no difference in the 5-year overall survival rate. But the existence of a survival advantage after 10 years supports the theory that preservation of renal function is important for long-term outcomes.

The authors note that while their findings conflict with a randomized trial performed by the European Organisation for Research and Treatment of Cancer, every patient in their study was analyzed with respect to the treatment they actually received.

“With the increase in number of surgeries to remove renal masses in recent years, subsequent SEER analyses of larger cohorts may allow for more powerful analysis,” they conclude.

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