Presentation Authors: Eric Gourley*, Hanzhang Wang, Deepak Pruthi, Dharam Kaushik, Michael Liss, Ahmed Mansour, San Antonio, TX
Introduction: Controversy exists regarding the efficacy of partial nephrectomy (PN) in the setting of pathologically upstaged renal cell carcinoma (RCC). We aimed to investigate the predictors of pT3a upstaging as well as survival outcomes in the setting of partial versus radical nephrectomy (RN).
Methods: We investigated the National Cancer Database (NCDB) for patients with cT1-2 N0M0 RCC who underwent RN or PN. Patients who were upstaged to pT3a were further identified and stratified according to clinical stage and surgical procedure. Multivariate logistic regression analysis was fitted to identify independent predictors of pathological upstaging. Kaplan-Meier analysis with log rank test was performed to evaluate overall survival (OS) among different groups.
Results: Between 2004 to 2015, 180,981 patients with cT1-2 N0M0 RCC who underwent RN or PN were identified in the NCDB. Of them, 11,828 (6.54%) patients were upstaged to pT3a postoperatively. _x000D_
Predictors of upstaging on multivariate analysis were male gender, cT2 stage and having radical nephrectomy. Five-year OS for cT1 upstaged patients who underwent PN vs RN was 83.8 % vs 67.3% (95% CI, 81.1-86.2 and 65.4- 69.2, respectively) (p < 0.001). While among cT2 upstaged group 67.0% vs 65.0% (95% CI , 56.5- 74.9 and 63.0-66.9, (p 0.33) respectively) Figure 1 . _x000D_
Cox proportional hazard modeling identified advancing age, cT2 stage and non-Hispanic ethnicity as independent predictors of OS
Conclusions: pT3a upstaging had significant impact on overall survival. PN was not inferior to RN in upstaged patients with initial cT2 disease. Moreover, PN conferred a 5-year survival advantage in patients with initial cT1 disease.