Partial Nephrectomy Improves Survival in Early Kidney Cancer

For patients with small, early-stage kidney cancers, overall survival is better with partial nephrectomy than with radical nephrectomy, reports a study in the Journal of the American Medical Association.

The study included 7138 Medicare fee-for-service patients who had surgery for clinical stage T1a kidney cancer between 1992 and 2007: radical nephrectomy in 73 percent of patients and partial nephrectomy in 27 percent. Patients undergoing partial nephrectomy were younger: about one- third were less than 70 years old, compared with one-fourth in the radical nephrectomy group. They were also more likely to be men, about 58 percent versus 54 percent, and to have a higher income and more years of education. The median follow-up time was 62 months.

Overall mortality was significantly lower in the partial nephrectomy group: 25.3 percent versus 41.5 percent for those who underwent radical nephrectomy, adjusted hazard ratio 0.54. There was no significant difference in kidney cancer–specific mortality: 1.9 percent versus 4.3 percent, respectively.

The percentage-point difference in survival with partial nephrectomy increased over time: from 5.6 at 2 years to 15.5 at 8 years. The data suggested that for every seven patients undergoing partial rather than radical nephrectomy, one additional life would be saved.

Previous reports have suggested that partial nephrectomy achieves similar oncologic control of early-stage kidney cancer, with better preservation of renal function, compared with radical nephrectomy. This large retrospective study found substantially better overall survival after partial nephrectomy in older adults with early kidney cancers. “[O]ur findings support partial nephrectomy as the preferred treatment option for the ever-expanding pool of patients with kidney tumors measuring 4 cm or smaller,” the researchers write. [Tan HJ, et al. Long-term survival following partial vs radical nephrectomy among older patients with early-stage kidney cancer. JAMA 2012; 307:1629–1635.]

June 2012 (Vol. 4, Number 6)