Competing-Risk Regression Analysis of Cancer-Specific and Other-Cause Mortality after Partial versus Radical Nephrectomy in T3aN0M0 Renal Cell Carcinoma.

Abstract

The optimal surgical management for T3aN0M0 renal cell carcinoma (RCC) remains debated. Radical nephrectomy (RN) is generally considered the standard treatment, whereas partial nephrectomy (PN) may preserve renal function, but the comparative long-term survival outcomes between these approaches remain unclear. Using the Surveillance, Epidemiology, and End Results (SEER) database, we compared cancer-specific mortality (CSM) and other-cause mortality (OCM) between PN and RN in patients with T3aN0M0 RCC. One-to-one propensity score matching (PSM) was performed. Cumulative incidence curves were generated, and univariable and multivariable Fine-Gray competing-risk regression (CRR) were applied to evaluate CSM and OCM. Subgroup analyses were performed by tumor size and age. A total of 17,032 patients were included, of whom 2805 underwent PN and 14,227 underwent RN. After PSM, multivariable CRR analysis showed that PN was not associated with increased CSM compared with RN in the overall matched cohort (subdistribution hazard ratio (sHR) 0.77; 95% confidence interval (CI) 0.65-0.90; p < 0.001), with similar findings across subgroup analyses. PN was associated with lower OCM in patients with tumors measuring 1-40 mm (sHR 0.84; 95% CI 0.71-0.99; p = 0.036), whereas no significant OCM difference was observed in other subgroups. PN was not associated with a higher hazard of CSM or OCM than RN in this matched cohort. Our findings should be interpreted cautiously given the inherent limitations of the retrospective study design. PN may be considered in carefully selected patients with smaller tumors when complete resection is feasible without compromising oncologic safety.