Partial (Vs. Radical) Nephrectomy Improves Survival in Older Patients

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(ChemotherapyAdvisor) – Medicare-insured patients with early-stage kidney cancer treated with partial nephrectomy had improved survival compared with those treated with radical nephrectomy, according to a study in the April 18 issue of JAMA, a theme issue on comparative effectiveness research.

“Although partial nephrectomy is the preferred treatment for many patients with early-stage kidney cancer, recent clinical-trial data, which demonstrate better survival for patients treated with radical nephrectomy, have generated new uncertainty regarding the comparative effectiveness of these treatment options,” investigators from the University of Michigan Comprehensive Cancer Center wrote. “Our findings suggest that by judiciously expanding the use of partial nephrectomy, clinicians can optimize survival outcomes among patients seeking treatment for early-stage kidney cancer.”

The retrospective cohort study examined 7,138 Medicare beneficiaries with clinical stage T1a kidney cancer treated with partial or radical nephrectomy from 1992 through 2007 who were followed for up to eight years after treatment. A total of 1,925 patients (27%) were treated with partial nephrectomy and 5,213 patients (73%) with radical nephrectomy.

During a median follow-up of 62 months, 487 (25.3%) patients had died following partial nephrectomy and 2,164 (41.5%) following radical nephrectomy. Kidney cancer was the cause of death for 37 patients (1.9%) treated with partial nephrectomy and 222 (4.3%) treated with radical nephrectomy. Patients treated with partial nephrectomy had a significantly lower risk of death (HR 0.54). Predicted survival increase with partial nephrectomy was 5.6% at two years, 11.8% at five years, and 15.5% at eight years posttreatment (P<0.001). No difference was noted in kidney cancer–specific survival (HR 0.82).


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