Comparison of survival rates in stage 1 renal cell carcinoma between partial nephrectomy and radical nephrectomy patients according to age distribution: a propensity score matching study.

Abstract

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. 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. 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). Only the oldest group of patients showed significantly better OS for PN compared with RN; however, we still recommend PN in young patients.