Objectives: This study compared the long-term efficacy and prognostic factors of partial nephrectomy (PN) and radical nephrectomy (RN) for T1bN0M0 renal cell carcinoma (RCC) using data from the Surveillance, Epidemiology, and End Results database.
Materials and methods: We retrospectively analyzed the clinical data of 12,471 patients diagnosed with T1bN0M0 RCC from the Surveillance, Epidemiology, and End Results database between 2010 and 2019. Patients were divided into the PN and RN groups, and propensity score matching was conducted to balance the differences between the groups. We compared overall survival (OS), RCC cancer-specific mortality (CSM), and noncancer-specific mortality (NCSM) between the 2 groups. The risk factors for all-cause and RCC-related mortality were analyzed.
Results: After propensity score matching, there were 3817 patients in each group. After matching, OS and NCSM were significantly longer in the PN group (p < 0.001); however, there was no significant between-group difference in the RCC-CSM. The hazard ratio (HR) for all-cause mortality was significantly lower in the PN group (HR, 0.671; 95% confidence interval [CI], 0.579-0.778, p < 0.001), but PN was not associated with lower RCC-related mortality. Subgroup analysis showed that PN reduced the HR of all-cause mortality by 35% (HR, 0.647; 95% CI, 0.536-0.781; p < 0.001) in patients with 4.0- to 5.5-cm tumors compared with RN and by 29% (HR, 0.709; 95% CI, 0.559-0.899; p = 0.004) in those with larger tumors (5.6-7.0 cm). Multifactorial analysis showed that PN was an independent predictor of OS (HR, 0.671; 95% CI, 0.579-0.778; p < 0.001). In addition, multivariate analysis validated that age at diagnosis, sex, pathological grade, and tumor size were associated with outcomes.
Conclusions: In patients with T1b RCC, PN resulted in better OS and NCSM outcomes than RN. The benefit of PN in all-cause mortality was pronounced in patients with 4.0-5.5 cm tumor loads. Therefore, individualized treatment schemes should prioritize PN, when technically feasible.
Acknowledgments
None.
Statement of ethics
The data published in the SEER database are anonymous and do not require informed patient consent; therefore, this study did not require an ethics statement. All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Conflict of interest statement
JL is an Associate Editor and FW is one member of Editorial Board of Current Urology. This article was accepted after normal external peer review. The other authors have declared no conflict of interest.
Funding source
This project was supported by the Shandong Provincial Nature Science Foundation (ZR2020QH240), the National Nature Science Foundation of China (NSFC82002719), the Clinical Medicine Innovation Program of Jinan City (202019125), and the China Postdoctoral Science Foundation (2022M711977).
Author contribution
JL, HN, KR: Conceived and designed the study;
JJL, HN, FW, HW, KR: Collected the data and analyzed the data;
KR: Drafted the manuscript;
FW: Reviewed and edited the manuscript and supervised the research;
All authors contributed to the article and approved the submitted version.
Data availability
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
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