Cytoreductive Partial Nephrectomy versus Cytoreductive Radical Nephrectomy for Locally T₁ Stage Metastatic Renal Rell Carcinoma (mRCC)

  Objective   To explore whether cytoreductive partial nephrectomy (cPN) or cytoreductive radical nephrectomy (cRN), is more beneficial for patients with locally T₁ stage metastatic renal cell carcinoma (mRCC).

  Methods   We retrospectively collected the data ofthe patients with locally T₁ stage mRCC (n=934) from the Surveillance, Epidemiology, and End Results (SEER) database. Logistic regression was conducted to identify the determinants of cPN. Propensity-score match (PSM) was used to diminish the confounder. Kaplan-Meier survival analyses was performed and multivariable Cox proportional hazards model was used to evaluate the effect of cPN and cRN on overall survival (OS) and cancer specific survival (CSS).

  Results   Among the 934 patients, 142 (15.2%) received cPN and 792 (84.8%) received cRN. Before PSM, both OS and CSS in cPN group were better in Kaplan-Meier analysis (log rank test, each P< 0.01). In a survival analysis of propensity-score matched 141 pairs of patients, cPN was still associated with improved OS and CSS compared with cRN (log rank test, each P< 0.01). After PSM, the 2-year OS were 61.7% and 74.4%, and 5-year OS were 35.6% and 59.2% in the cRN and cPN cohorts respectively. Cox proportional hazards model confirmed cPN the independent risk factor of both OS and CSS.

  Conclusion   For mRCC patients with locally T₁ stage, cPN may gain an OS and CSS benefit compared with cRN.