Real-World Survival Outcomes of Partial Versus Radical Nephrectomy: Cause-Specific and Time-Dependent Effects.

Abstract

Objectives: To assess the prognosis of radical nephrectomy (RN) and partial nephrectomy (PN) in patients with localized renal cell carcinoma (RCC), with particular consideration of cause-specific mortality and time-dependent effects on real-world survival outcomes.

Patients and methods: This multicenter, retrospective study included patients with localized RCC who underwent RN or PN; 1:1 propensity score matching was conducted to minimize selection bias in the nonrandom assignment of patients to the PN and RN groups. Overall survival (OS), cancer-specific mortality (CSM), and other-cause mortality (OCM) were evaluated in patients who underwent RN or PN using conditional survival (CS) analysis.

Results: In total, 802 patients were included in the RN and PN groups (401 patients in each). The RN group had a significantly poorer OS than the PN group (P = .031). CS analysis indicated that neither the RN nor the PN groups had significantly enhanced survival rates over extended survival periods. The CS rate was consistently higher in the PN group than in the RN group at all time points during follow-up. Only the conditional cumulative incidence of OCM in the RN group was consistently high during the follow-up period, but that of OCM in the PN group and CSM in these groups remained low, irrespective of the length of survival.

Conclusion: PN was associated with better OS than RN in patients with localized RCC. CS analysis revealed this was attributed to a consistently high rate of OCM in the RN group during the follow-up period.