DISEASE OUTCOME IN PATIENTS WITH LOW STAGE RENAL-CELL CARCINOMA TREATED WITH NEPHRON SPARING OR RADICAL SURGERY

Purpose: We investigated the outcome of nephron sparing surgery in pat ients with low grade and low stage (Robson stage II or less) renal cel l carcinoma. Materials and Methods: We retrospectively reviewed the re cords of 185 patients treated with nephron sparing surgery and 209 mat ched for patient age and sex, and tumor stage and grade who were treat ed with radical nephrectomy, Kaplan-Meier survival curves were constru cted for progression and survival end points. Multivariate-analysis wa s performed to determine the tumor characteristics independently corre lated with progression and cancer death. Results: No significant diffe rence was observed with respect to progression-free, crude or cancer s pecific survival between the nephron sparing surgery and radical nephr ectomy groups. Less than 5% of the patients treated with conservative nephron sparing surgery had local recurrence. Tumor size was a strong independent predictor of outcome, whereas Robson stage was not. Patien ts treated with radical nephrectomy had a significant cancer specific and progression-free survival advantage when controlling for tumor dia meter and grade. However, no difference was observed in patients with primary tumor diameters of 4 cm, or less. Conclusions: Robson staging is inaccurate in predicting tumor behavior. Patients with tumors large r than 4 cm. and a normal contralateral kidney may be best served by r adical nephrectomy rather than elective nephron sparing surgery. Howev er, nephron sparing surgery may result in an outcome similar to that o f radical nephrectomy for low grade, low stage renal cell carcinomas o f 4 cm. or smaller.