NEW YORK (Reuters Health) – New research supports current clinical guidance to perform partial nephrectomy (PN) when possible in patients with clinically organ-confined renal cell tumors 7 centimeters or smaller (cT1).

In a retrospective comparative study, clinicians from Italy found that elective PN was equivalent to radical nephrectomy (RN) in this patient population; it was not associated with an increased risk of recurrence or cancer-related death.

Dr. Alessandro Antonelli from University of Brescia and colleagues report their observations in BJU International, available online now.

Using a multi-institutional database, they compared the outcomes of 3,480 patients with cT1N0M0 renal cell carcinoma who underwent elective PN or RN.

They report that patients with cT1 disease who are suitable for elective PN have a “limited risk” of clinical understaging. In patients who underwent PN, the risk of clinical understaging was 3.2% in cT1a cases and 10.6% in cT1b cases.

At a median follow-up of 47 months, 90 patients (3%) were alive but in progression, 178 (5%) had died from their disease, 210 (6%) had died from other causes, and the remaining 3,002 patients (86%) were alive and disease-free.

Local recurrences occurred in 10 patients (0.5%) with tumors 4 centimeters or smaller (cT1a) and in nine patients (0.6%) with tumors 4.1 to 7 centimeters in size (cT1b).

In cT1a patients, local recurrences occurred in five patients (0.6%) after RN and in five (0.5%) patients after PN (P = 0.79). Similarly, in cT1b patients, local recurrences occurred in seven patients (0.5%) after RN and in two (1%) after PN (P = 0.41).

For cT1a patients, 5- and 10-year cancer-specific survival estimates were 95% and 90%, respectively, after RN and 96% and 95%, respectively, after PN (log-rank test: P = 0.01).

For cT1b patients, the corresponding percentages were 93% and 87% after RN, and90% and 90% after PN (log-rank test: P = 0.89).

In multivariable analysis, surgical treatment was not an independent predictor of cancer-specific survival, both for cT1a and cT1b patients.

“Interestingly,” note the researchers, PN was also “oncologically equivalent to RN” in patients with pathological stage T3a tumors (log-rank test: P = 0.91).

This analysis, they conclude, indicates that nephron-sparing surgery is not associated with an increased risk of recurrence and cancer-specific mortality both in cT1a and cT1b tumors.

“The data obtained in the present study,” they write, “strongly support the current recommendations of the international guidelines, which consider PN to be the gold standard treatment for T1a tumours and a safe oncological treatment in selected T1b tumours.”

BJU Int 2011. Published online August 24, 2011.