Journal
BJU INTERNATIONAL
Volume 117, Issue 6B, Pages E52-E59Publisher
WILEY-BLACKWELL
DOI: 10.1111/bju.13200
Keywords
nephrectomy; kidney function; kidney disease; chronic
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Objective To assess differences in overall survival (OS) between patients receiving partial nephrectomy (PN) and radical nephrectomy (RN) for stage 1 renal cell carcinoma (RCC) according to age distribution, as the survival advantage of PN vs RN has been unclear owing to conflicting data. Patients and Methods We studied 952 patients with stage 1 RCC who underwent either PN or RN. Patients were divided into three groups according to age: Group 1 (<= 54 years), Group 2 (55-64 years), and Group 3 (>= 65 years). Patient variables including age, body mass index, sex, presence of hypertension (HT) and/or diabetes mellitus (DM), performance status, tumour size, pathological diagnosis, nuclear grade, and preoperative estimated glomerular filtration rate (eGFR), were adjusted using 1: 1 propensity score matching between PN and RN. Results Group 1 included 66 matched patients; Group 2, 72; and Group 3, 70. Group 1 tended to have higher preoperative eGFR values and lower rates of HT and DM compared with Groups 2 and 3. Postoperative eGFR dropped by 11-13% in PN patients and by 34-36% in RN patients. In Group 3, PN patients had longer OS than RN patients (5-year OS: PN 96%, RN 81%, P = 0.043); however, there was no significant difference in Group 1 (5-year OS: PN 100%, RN 93%, P = 0.302) or Group 2 (5-year OS: PN 94%, RN 87%, P = 0.358). Conclusions Only the oldest group of patients showed significantly better OS for PN compared with RN; however, we still recommend PN in young patients.
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